Methods for treating visceral pain by administering antagonist antibodies directed against calcitonin gene-related peptide

ABSTRACT

The invention features methods for preventing or treating visceral pain, including pain associated with functional bowel disorder, inflammatory bowel disease and interstitial cystitis, by administering an anti-CGRP antagonist antibody.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 14/855,959, filed Sep. 16, 2015, which is a continuation of U.S. patent application Ser. No. 14/295,583, filed Jun. 4, 2014, which is a continuation of U.S. patent application Ser. No. 14/057,747, filed Oct. 18, 2013, which is a continuation of U.S. patent application Ser. No. 13/392,860, filed Feb. 27, 2012 (now U.S. Pat. No. 8,623,366), which is a national stage of PCT International Application No. PCT/162010/053787, filed Aug. 23, 2010, which claim the priority benefit of provisional patent application U.S. Ser. No. 61/237,901 filed on Aug. 28, 2009, said applications are incorporated herein by reference in their entireties.

REFERENCE TO SEQUENCE LISTING

This application is being filed electronically and includes an electronically submitted sequence listing in .txt format. The .txt file contains a sequence listing entitled “44306704304SeqList.txt” created on Apr. 21, 2016 and having a size of 28 KB. The sequence listing contained in this .txt file is part of the specification and is herein incorporated by reference in its entirety.

FIELD

The invention relates to a method of treating and/or preventing visceral pain and/or symptoms of visceral pain using an anti-CGRP antibody, and to an anti-CGRP antibody for use in the prevention and/or treatment of visceral pain and/or symptoms of visceral pain.

BACKGROUND

Visceral pain is a leading cause of patient visits to the clinic, yet effective treatments for visceral pain are limited. Visceral pain is difficult to manage clinically and often requires the use of opiates. Although widely used, the severe dose-limiting adverse effects of opiates often result in diminished efficacy. Additionally, opiates carry the risk of abuse and physical dependence and induce constipation and other unwanted adverse effects, which are contraindicated in many cases and diminish quality of life.

Visceral pain is pain associated with the viscera, which encompass the internal organs of the body. These organs include, e.g., the heart, lungs, reproductive organs, bladder, ureters, the digestive organs, liver, pancreas, spleen, and kidneys. There are a variety of conditions in which visceral pain may exist, such as, for example, pancreatitis, labor, abdominal surgery associated with ileus, cystitis, menstrual period, or dysmenorrhea. Likewise, kidney pain, epigastric pain, pleural pain, and painful biliary colic, appendicitis pain may all be considered to be visceral pain. Substernal pain or pressure from early myocardial infarction is also visceral. Diseases of the stomach, dudenum or colon can cause visceral pain. Commonly encountered gastrointestinal (GI) disorders that cause visceral pain include functional bowel disorder (FBD) and inflammatory bowel disease (IBD). These GI disorders include a wide range of disease states that are currently only moderately controlled, including, with respect to FBD, gastro-esophageal reflux, dyspepsia, irritable bowel syndrome (IBS) and functional abdominal pain syndrome (FAPS), and, with respect to IBD, Crohn's disease, ileitis and ulcerative colitis, all of which regularly produce visceral pain.

IBS affects 10-20% of adults and adolescents worldwide (Longstreth et al., 2006, Gastroenterology 130(5):1480-91). The primary reason these patients seek medical attention is chronic visceral pain believed to be due to enhanced visceral sensitivity (Aziz, 2006, Gastroenterology 131(2):661-4). Patients with IBS have been shown to have a lower visceral sensory threshold to colorectal distension and that this is highly correlated to the visceral pain symptoms (Delafoy et al, 2006, Gut 55(7):940-5). Colorectal distension after trinitrobenzene sulfonic acid (TNBS) induced colitis in rats is an animal model that has been used by many researchers to explore the mechanisms of visceral hypersensitivity (Gay et al, 2006, Neuroimmunomodulation 23; 13(2):114-121; Delafoy et al, 2006; Adam et al., 2006, Pain 123(1-2):179-86).

Interstitial cystitis (IC) is a painful bladder syndrome characterized in the clinic by urinary urgency, frequency and chronic pelvic pain. Clinical studies indicate that this involves visceral sensory afferent nerve hypersensitivity where the sensation of bladder fullness occurs at lower than patients indicates an increase in nerve density in the submucosa of the bladder and evidence of neurogenic inflammation further normal volumes and bladder fullness is perceived as painful. Histopathology of IC suggests the involvement of visceral afferents.

Visceral pain can be produced in response to, for example, inflammation, distention, or increased pressure. It is not always elicited by visceral injury. In addition, visceral pain is diffuse, may be referred to other locations; and may be associated with other autonomic and motor reflexes (e.g., nausea, lower-back muscle tension from renal colic) (Lancet 1999, 353, 2145-48).

CGRP (calcitonin gene-related peptide) is a 37 amino acid neuropeptide, which belongs to a family of peptides that includes calcitonin, adrenomedullin and amylin. In humans, two forms of CGRP (α-CGRP and β-CGRP) exist and have similar activities.

They vary by three amino acids and exhibit differential distribution. At least two CGRP receptor subtypes may also account for differential activities. CGRP is a neurotransmitter in the central nervous system, and has been shown to be a potent vasodilator in the periphery, where CGRP-containing neuronal processes are closely associated with blood vessels. CGRP-mediated vasodilatation is also associated with neurogenic inflammation, as part of a cascade of events that results in extravasation of plasma and vasodilation of the microvasculature and is present in migraine.

Spinally administered small molecule selective CGRP antagonists have been shown to be useful in the treatment of neuropathic and nociceptive pain conditions (Adwanikar et al, Pain, 2007, 132(1-2):53-66) suggesting that removal of endogenous CGRP signalling in the spinal cord has an antinociceptive effect. Reports have established that blocking CGRP signalling is effective in reversing visceral hypersensitivity (VH) by systemically injecting CGRP 8-37, a CGRP receptor antagonist (Delafoy et al., 2006; Plourde et al., 1997, Am J Physiol. 273(1 Pt 1):G191-6; Julia and Bueno, 1997, Am J Physiol. 272(1 Pt 1):G141-6). However, CGRP 8-37 has a very short half-life in-vivo and would therefore not be a useful therapeutic. Thus, there is a critical medical need to identify new therapeutics for the treatment and prevention of visceral pain.

Throughout this application various publications (including patents and patent applications) are referenced. The disclosures of these publications in their entireties are hereby incorporated by reference.

SUMMARY OF THE INVENTION

The present invention provides a method for preventing and/or treating visceral pain and/or symptoms of visceral pain in an individual, the method comprising administering a therapeutically effective amount of an anti-CGRP antagonist antibody to an individual suffering from or at risk for visceral pain.

In some embodiments, the anti-CGRP antagonist antibody administered peripherally. In other embodiments, the anti-CGRP antagonist antibody is administered orally, sublingually, via inhalation, transdermally, subcutaneously, intravenously, intra-arterially, intra-articularly, peri-articularly, locally and/or intramuscularly.

In some embodiments, the visceral pain is associated with a functional bowel disorder (FBD). The FBD may be gastro-esophageal reflux, dyspepsia, irritable bowel syndrome (IBS) and functional abdominal pain syndrome (FAPS). In some embodiments, the visceral pain is associated with inflammatory bowel disease (IBD). The IBD may be Crohn's disease, ileitis or ulcerative colitis. In some embodiments, the visceral pain is associated with renal colic, dysmenorrhea, cystitis, menstrual period, labor, menopause, prostatitis or pancreatitis. In some embodiments, the visceral pain is associated interstitial cystitis (IC).

In some embodiments, the anti-CGRP antagonist antibody binds to CGRP; blocks CGRP from binding to its receptor; blocks or decreases CGRP receptor activation; inhibits blocks, suppresses or reduces CGRP biological activity; increases clearance of CGRP; and/or inhibits CGRP synthesis, production or release.

In some embodiments, the anti-CGRP antagonist antibody is a human antibody or a humanized antibody. In some embodiments, the anti-CGRP antagonist antibody is a monoclonal antibody. In some embodiments, the anti-CGRP antagonist antibody can bind CGRP with a KD of 50 nM or less (as measured by surface plasmon resonance at 37° C. and/or has a half life in-vivo of at least 7 days).

In some embodiments, the anti-CGRP antagonist antibody specifically binds to the C-terminal region of CGRP. In some embodiments, the anti-CGRP antagonist antibody specifically recognizes the epitope defined by the sequence GSKAF (SEQ ID NO: 39). In some embodiments, the anti-CGRP antagonist antibody comprises a VH domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 1 or 19.

In some embodiments, the anti-CGRP antagonist antibody comprises a VL domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 2 or 20. In some embodiments, the anti-CGRP antagonist antibody further comprises a VH domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 1 or 19. In other embodiments, the anti-CGRP antibody comprises at least one CDR selected from the group consisting of: (a) CDR H1 as set forth in SEQ ID NO: 3, 21, 33, 34, 36 or 37; (b) CDR H2 as set forth in SEQ ID NO: 4, 22, 35 or 38; (c) CDR H3 as set forth in SEQ ID NO: 5 or 23; (d) CDR L1 as set forth in SEQ ID NO: 6 or 24; (e) CDR L2 as set forth in SEQ ID NO: 7 or 25; (f) CDR L3 as set forth in SEQ ID NO: 8 or 26; and (g) variants of L1, L2 and H2.

In some embodiments, the anti-CGRP antibody comprises the antibody G1 heavy chain full antibody amino acid sequence shown in SEQ ID NO: 11, with or without the C-terminal lysine. In some embodiments, the anti-CGRP antibody comprises the antibody G1 light chain full antibody amino acid sequence shown in SEQ ID NO: 12. In some embodiments, the anti-CGRP antibody comprises the antibody G1 heavy chain full antibody amino acid sequence shown in SEQ ID NO: 11, with or without the C-terminal lysine; and the antibody G1 light chain full antibody amino acid sequence shown in SEQ ID NO: 12.

In some embodiments, the anti-CGRP antibody comprises the antibody G2 heavy chain full antibody amino acid sequence shown in SEQ ID NO: 29, with or without the C-terminal lysine. In some embodiments, the anti-CGRP antibody comprises the antibody G2 light chain full antibody amino acid sequence shown in SEQ ID NO: 30. In some embodiments, the anti-CGRP antibody comprises the antibody G2 heavy chain full antibody amino acid sequence shown in SEQ ID NO: 29; and the antibody G2 light chain full antibody amino acid sequence shown in SEQ ID NO: 30.

In some embodiments, the anti-CGRP antagonist antibody comprises a VH domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 1 and a VL domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 2. In some embodiments, the anti-CGRP antagonist antibody comprises a heavy chain produced by the expression vector with ATCC Accession No. PTA-6867. In some embodiments, the anti-CGRP antagonist antibody comprises a light chain produced by the expression vector with ATCC Accession No. PTA-6866. In some embodiments, the anti-CGRP antagonist antibody is produced by the expression vectors with ATCC Accession Nos. PTA-6867 and PTA-6866.

In some embodiments, the anti-CGRP is administered by subcutaneous or intravenous injection between once, twice, three or four times per month. In some embodiments, the anti-CGRP antagonist antibody is administered at a concentration of between 5 to 100 mg/ml. In some embodiments, the anti-CGRP antagonist antibody is administered at a concentration of between 1 to 100 mg/kg of body weight.

In some embodiments, the anti-CGRP antagonist antibody does not produce CNS impairment of motor coordination or attention. In some embodiments, the anti-CGRP antagonist antibody is not administered centrally, spinally or intrathecally. In some embodiments, the anti-CGRP antagonist antibody is not a centrally, spinally or intrathecal penetrating molecule.

In some embodiments, the anti-CGRP antagonist antibody is administered separately, sequentially or simultaneously in combination with one or more further pharmacologically active compounds. In some embodiments, the one or more further pharmacologically active compounds is/are selected from: an opioid analgesic, e.g. morphine, heroin, hydromorphone, oxymorphone, levorphanol, levallorphan, methadone, meperidine, fentanyl, cocaine, codeine, dihydrocodeine, oxycodone, hydrocodone, propoxyphene, nalmefene, nalorphine, naloxone, naltrexone, buprenorphine, butorphanol, nalbuphine or pentazocine; a nonsteroidal antiinflammatory drug (NSAID), e.g. aspirin, diclofenac, diflusinal, etodolac, fenbufen, fenoprofen, flufenisal, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamic acid, mefenamic acid, nabumetone, naproxen, oxaprozin, phenylbutazone, piroxicam, sulindac, tolmetin or zomepirac, or a pharmaceutically acceptable salt thereof; a barbiturate sedative, e.g. amobarbital, aprobarbital, butabarbital, butabital, mephobarbital, metharbital, methohexital, pentobarbital, phenobartital, secobarbital, talbutal, theamylal or thiopental or a pharmaceutically acceptable salt thereof; a benzodiazepine having a sedative action, e.g. chlordiazepoxide, clorazepate, diazepam, flurazepam, lorazepam, oxazepam, temazepam or triazolam or a pharmaceutically acceptable salt thereof; an H1 antagonist having a sedative action, e.g. diphenhydramine, pyrilamine, promethazine, chlorpheniramine or chlorcyclizine or a pharmaceutically acceptable salt thereof; a sedative such as glutethimide, meprobamate, methaqualone or dichloralphenazone or a pharmaceutically acceptable salt thereof; a skeletal muscle relaxant, e.g. baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, methocarbamol or orphrenadine or a pharmaceutically acceptable salt thereof; an NMDA receptor antagonist, e.g. dextromethorphan ((+)-3-hydroxy-N-methylmorphinan) or its metabolite dextrorphan ((+)-3-hydroxy-N-methylmorphinan), ketamine, memantine, pyrroloquinoline quinone or cis-4-(phosphonomethyl)-2-piperidinecarboxylic acid or a pharmaceutically acceptable salt thereof; an alpha-adrenergic, e.g. doxazosin, tamsulosin, clonidine or 4-amino-6,7-dimethoxy-2-(5-methanesulfonamido-1,2,3,4-tetrahydroisoquinol-2-yl)-5-(2-pyridyl) quinazoline; a tricyclic antidepressant, e.g. desipramine, imipramine, amytriptiline or nortriptiline; an anticonvulsant, e.g. carbamazepine or valproate; a tachykinin (NK) antagonist, particularly an NK-3, NK-2 or NK-1 antagonist, e.g. (αR,9R)-7-[3,5-bis(trifluoromethyl)benzyl]-8,9,10,11-tetrahydro-9-methyl-5-(4-methylphenyl)-7H-[1,4]diazocino[2,1-g][1,7]naphthridine-6-13-dione (TAK-637), 5-[[(2R,3S)-2-[(1R)-1-[3,5-bis(trifluoromethyl)phenyl]ethoxy-3-(4-fluorophenyl)-4-morpholinyl]methyl]-1,2-dihydro-3H-1,2,4-triazol-3-one (MK-869), lanepitant, dapitant or 3-[[2-methoxy-5-(trifluoromethoxy)phenyl]methylamino]-2-phenyl-piperidine (2S,3S); a muscarinic antagonist, e.g oxybutin, tolterodine, propiverine, tropsium chloride or darifenacin; a COX-2 inhibitor, e.g. celecoxib, rofecoxib or valdecoxib; a non-selective COX inhibitor (preferably with GI protection), e.g. nitroflurbiprofen (HCT-1026); a coal-tar analgesic, in particular paracetamol; neuroleptic such as droperidol; a vanilloid receptor agonist (e.g. resinferatoxin) or antagonist (e.g. capsazepine); a beta-adrenergic such as propranolol; a local anaesthetic, such as mexiletine; a corticosteriod, such as dexamethasone; a serotonin receptor agonist or antagonist; a cholinergic (nicotinic) analgesic; Tramadol®; a PDEV inhibitor, such as sildenafil, vardenafil or taladafil; an alpha-2-delta ligand such as gabapentin or pregabalin; and a canabinoid.

The present invention further provides the use of an anti-CGRP antagonist antibody for the manufacture of a medicament for the prevention and/or treatment of visceral pain and/or symptoms of visceral pain. In some embodiments, the medicament is prepared to be peripherally administered. In some embodiments, the anti-CGRP antagonist antibody acts peripherally on administration.

The present invention further provides a pharmaceutical composition for treatment and/or prevention of visceral pain and/or symptoms of visceral pain in an individual, comprising an anti-CGRP antagonist antibody and a pharmaceutically acceptable carrier. In some embodiments the composition is prepared to be peripherally administered.

The present invention further provides a kit comprising: a pharmaceutical composition for treatment and/or prevention of visceral pain and/or symptoms of visceral pain in an individual, and instructions for the peripheral administration of a therapeutically effective amount of said pharmaceutical composition to an individual for treatment and/or prevention of visceral pain and/or symptoms of visceral pain.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B depict a visceral pain model. (A) Antibody 4901 (“4901”) or PBS control (“Vehicle”) was administered intravenously into animals injected with trinitrobenzene sulfonic acid (TNBS) after abdominal laparotomy. Visceral pain threshold in the animals was tested using balloon distension. Pain threshold is indicated in mm Hg (y-axis). Sham represents animals injected with a control (30% ethanol) solution instead of TNBS after laparotomy. (B) CGRP receptor antagonist CGRP 8-37 or PBS control (“Vehicle”) was administered intravenously into TNBS-treated animals after abdominal laparotomy. As in (A), visceral pain threshold in the animals was tested using balloon distension, and pain threshold is indicated in mm Hg (y-axis).

FIG. 2 depicts a visceral pain model. Antibody 4901 (“4901”) or PBS control (“Vehicle”) was administered intravenously into animals. Bladder motility, measured as number of contractions (y-axis), was tested at 1 h, 3 h and 5 h after turpentine-induced bladder inflammation.

DETAILED DESCRIPTION OF THE INVENTION

The invention disclosed herein provides methods for treating and/or preventing visceral pain in an individual by administering to the individual a therapeutically effective amount of an anti-CGRP antagonist antibody.

The invention disclosed herein also provides anti-CGRP antagonist antibodies and polypeptides derived from G1 or its variants shown in Table 6 of WO2007/054809, which is hereby incorporated by reference in its entirety. The invention also provides methods of making and using these antibodies and polypeptides.

General Techniques

The practice of the present invention will employ, unless otherwise indicated, conventional techniques of molecular biology (including recombinant techniques), microbiology, cell biology, biochemistry and immunology, which are within the skill of the art. Such techniques are explained fully in the literature, such as, Molecular Cloning: A Laboratory Manual, second edition (Sambrook et al., 1989) Cold Spring Harbor Press; Oligonucleotide Synthesis (M. J. Gait, ed., 1984); Methods in Molecular Biology, Humana Press; Cell Biology: A Laboratory Notebook (J. E. Cellis, ed., 1998) Academic Press; Animal Cell Culture (R.I. Freshney, ed., 1987); Introduction to Cell and Tissue Culture (J. P. Mather and P. E. Roberts, 1998) Plenum Press; Cell and Tissue Culture: Laboratory Procedures (A. Doyle, J. B. Griffiths, and D. G. Newell, eds., 1993-1998) J. Wiley and Sons; Methods in Enzymology (Academic Press, Inc.); Handbook of Experimental Immunology (D. M. Weir and C. C. Blackwell, eds.); Gene Transfer Vectors for Mammalian Cells (J. M. Miller and M. P. Calos, eds., 1987); Current Protocols in Molecular Biology (F. M. Ausubel et al., eds., 1987); PCR: The Polymerase Chain Reaction, (Mullis et al., eds., 1994); Current Protocols in Immunology (J. E. Coligan et al., eds., 1991); Short Protocols in Molecular Biology (Wiley and Sons, 1999); Immunobiology (C. A. Janeway and P. Travers, 1997); Antibodies (P. Finch, 1997); Antibodies: a practical approach (D. Catty., ed., IRL Press, 1988-1989); Monoclonal antibodies: a practical approach (P. Shepherd and C. Dean, eds., Oxford University Press, 2000); Using antibodies: a laboratory manual (E. Harlow and D. Lane (Cold Spring Harbor Laboratory Press, 1999); The Antibodies (M. Zanetti and J. D. Capra, eds., Harwood Academic Publishers, 1995).

Definitions

An “antibody” is an immunoglobulin molecule capable of specific binding to a target, such as a carbohydrate, polynucleotide, lipid, polypeptide, etc., through at least one antigen recognition site, located in the variable region of the immunoglobulin molecule. As used herein, the term encompasses not only intact polyclonal or monoclonal antibodies, but also fragments thereof (such as Fab, Fab′, F(ab′)2, Fv), single chain (ScFv), mutants thereof, fusion proteins comprising an antibody portion (such as domain antibodies), and any other modified configuration of the immunoglobulin molecule that comprises an antigen recognition site. An antibody includes an antibody of any class, such as IgG, IgA, or IgM (or sub-class thereof), and the antibody need not be of any particular class. Depending on the antibody amino acid sequence of the constant domain of its heavy chains, immunoglobulins can be assigned to different classes. There are five major classes of immunoglobulins: IgA, IgD, IgE, IgG, and IgM, and several of these may be further divided into subclasses (isotypes), e.g., IgG1, IgG2, IgG3, IgG4, IgA1 and IgA2. The heavy-chain constant domains that correspond to the different classes of immunoglobulins are called alpha, delta, epsilon, gamma, and mu, respectively. The subunit structures and three-dimensional configurations of different classes of immunoglobulins are well known.

As used herein, “monoclonal antibody” refers to an antibody obtained from a population of substantially homogeneous antibodies, i.e., the individual antibodies comprising the population are identical except for possible naturally-occurring mutations that may be present in minor amounts. Monoclonal antibodies are highly specific, being directed against a single antigenic site. Furthermore, in contrast to polyclonal antibody preparations, which typically include different antibodies directed against different determinants (epitopes), each monoclonal antibody is directed against a single determinant on the antigen. The modifier “monoclonal” indicates the character of the antibody as being obtained from a substantially homogeneous population of antibodies, and is not to be construed as requiring production of the antibody by any particular method. For example, the monoclonal antibodies to be used in accordance with the present invention may be made by the hybridoma method first described by Kohler and Milstein, 1975, Nature, 256:495, or may be made by recombinant DNA methods such as described in U.S. Pat. No. 4,816,567. The monoclonal antibodies may also be isolated from phage libraries generated using the techniques described in McCafferty et al., 1990, Nature, 348:552-554, for example.

As used herein, “humanized” antibodies refer to forms of non-human (e.g. murine) antibodies that are specific chimeric immunoglobulins, immunoglobulin chains, or fragments thereof (such as Fv, Fab, Fab′, F(ab′)₂ or other antigen-binding subsequences of antibodies) that contain minimal sequence derived from non-human immunoglobulin. For the most part, humanized antibodies are human immunoglobulins (recipient antibody) in which residues from a complementarity determining region (CDR) of the recipient are replaced by residues from a CDR of a non-human species (donor antibody) such as mouse, rat, or rabbit having the desired specificity, affinity, and biological activity. In some instances, Fv framework region (FR) residues of the human immunoglobulin are replaced by corresponding non-human residues. Furthermore, the humanized antibody may comprise residues that are found neither in the recipient antibody nor in the imported CDR or framework sequences, but are included to further refine and optimize antibody performance. In general, the humanized antibody will comprise substantially all of at least one, and typically two, variable domains (e.g., a heavy chain variable domain and a light chain variable domain), in which all or substantially all of the CDR regions correspond to those of a non-human immunoglobulin and all or substantially all of the FR regions are those of a human immunoglobulin consensus sequence. The humanized antibody optimally also will comprise at least a portion of an immunoglobulin constant region or domain (Fc), typically that of a human immunoglobulin. Antibodies may have Fc regions modified as described in WO 99/58572. Other forms of humanized antibodies have one or more CDRs (one, two, three, four, five, six) which are altered with respect to the original antibody, which are also termed one or more CDRs “derived from” one or more CDRs from the original antibody.

As used herein, “human antibody” means an antibody having an amino acid sequence corresponding to that of an antibody produced by a human and/or has been made using any of the techniques for making human antibodies known in the art or disclosed herein. This definition of a human antibody includes antibodies comprising at least one human heavy chain polypeptide or at least one human light chain polypeptide. One such example is an antibody comprising murine light chain and human heavy chain polypeptides. Human antibodies can be produced using various techniques known in the art. In one embodiment, the human antibody is selected from a phage library, where that phage library expresses human antibodies (Vaughan et al., 1996, Nature Biotechnology, 14:309-314; Sheets et al., 1998, PNAS, (USA) 95:6157-6162; Hoogenboom and Winter, 1991, J. Mol. Biol., 227:381; Marks et al., 1991, J. Mol. Biol., 222:581). Human antibodies can also be made by introducing human immunoglobulin loci into transgenic animals, e.g., mice in which the endogenous immunoglobulin genes have been partially or completely inactivated. This approach is described in U.S. Pat. Nos. 5,545,807; 5,545,806; 5,569,825; 5,625,126; 5,633,425; and 5,661,016. Alternatively, the human antibody may be prepared by immortalizing human B lymphocytes that produce an antibody directed against a target antigen (such B lymphocytes may be recovered from an individual or may have been immunized in vitro). See, e.g., Cole et al., Monoclonal Antibodies and Cancer Therapy, Alan R. Liss, p. 77, 1985; Boerner et al., 1991, J. Immunol., 147 (1):86-95; and U.S. Pat. No. 5,750,373.

As used herein, the term “calcitonin gene-related peptide” and “CGRP” refers to any form of calcitonin gene-related peptide and variants thereof that retain at least part of the activity of CGRP. For example, CGRP may be α-CGRP or β-CGRP. As used herein, CGRP includes all mammalian species of native sequence CGRP, e.g., human, canine, feline, equine, and bovine.

As used herein, an “anti-CGRP antagonist antibody” (interchangeably termed “anti-CGRP antibody”) refers to an antibody that is able to bind to CGRP and inhibit CGRP biological activity and/or downstream pathway(s) mediated by CGRP signaling. An anti-CGRP antagonist antibody encompasses antibodies that block, antagonize, suppress or reduce (including significantly) CGRP biological activity, including downstream pathways mediated by CGRP signaling, such as receptor binding and/or elicitation of a cellular response to CGRP. For purpose of the present invention, it will be explicitly understood that the term “anti-CGRP antagonist antibody” encompasses all the previously identified terms, titles, and functional states and characteristics whereby the CGRP itself, a CGRP biological activity (including but not limited to its ability to mediate any aspect of visceral pain), or the consequences of the biological activity, are substantially nullified, decreased, or neutralized in any meaningful degree. In some embodiment, an anti-CGRP antagonist antibody binds CGRP and prevents CGRP binding to a CGRP receptor. In other embodiments, an anti-CGRP antibody binds CGRP and prevents activation of a CGRP receptor. Examples of anti-CGRP antagonist antibodies are provided herein.

As used herein, the terms “G1” and “antibody G1” are used interchangeably to refer to an antibody produced by the expression vectors having deposit numbers ATCC-PTA-6867 and ATCC-PTA-6866. The amino acid sequence of the heavy chain and light chain variable regions are shown in SEQ ID NOs: 1 and 2. The CDR portions of antibody G1 (including Chothia and Kabat CDRs) are diagrammatically depicted in FIG. 5 of WO2007/054809, the content of which is herein incorporated by reference in its entirety. The polynucleotides encoding the heavy and light chain variable regions are shown in SEQ ID NOs: 9 and 10. The characterization of antibody G1 is described in the Examples of WO2007/054809.

As used herein, the terms “G2” and “antibody G2” are used interchangeably to refer to an anti-rat CGRP mouse monoclonal antibody as described in Wong H C et al. Hybridoma 12:93-106, 1993. The amino acid sequence of the heavy chain and light chain variable regions are shown in SEQ ID NOs: 19 and 20. The polynucleotides encoding the heavy and light chain variable regions are shown in SEQ ID NOs: 27 and 28. The CDR portions of antibody G2 are provided in SEQ ID NOs: 21 to 26.

The terms “polypeptide”, “oligopeptide”, “peptide” and “protein” are used interchangeably herein to refer to chains of amino acids of any length, preferably, relatively short (e.g., 10-100 amino acids). The chain may be linear or branched, it may comprise modified amino acids, and/or may be interrupted by non-amino acids. The terms also encompass an amino acid chain that has been modified naturally or by intervention; for example, disulfide bond formation, glycosylation, lipidation, acetylation, phosphorylation, or any other manipulation or modification, such as conjugation with a labeling component. Also included within the definition are, for example, polypeptides containing one or more analogs of an amino acid (including, for example, unnatural amino acids, etc.), as well as other modifications known in the art. It is understood that the polypeptides can occur as single chains or associated chains.

As known in the art, “polynucleotide,” or “nucleic acid,” as used interchangeably herein, refer to chains of nucleotides of any length, and include DNA and RNA. The nucleotides can be deoxyribonucleotides, ribonucleotides, modified nucleotides or bases, and/or their analogs, or any substrate that can be incorporated into a chain by DNA or RNA polymerase. A polynucleotide may comprise modified nucleotides, such as methylated nucleotides and their analogs. If present, modification to the nucleotide structure may be imparted before or after assembly of the chain. The sequence of nucleotides may be interrupted by non-nucleotide components. A polynucleotide may be further modified after polymerization, such as by conjugation with a labeling component. Other types of modifications include, for example, “caps”, substitution of one or more of the naturally occurring nucleotides with an analog, internucleotide modifications such as, for example, those with uncharged linkages (e.g., methyl phosphonates, phosphotriesters, phosphoamidates, carbamates, etc.) and with charged linkages (e.g., phosphorothioates, phosphorodithioates, etc.), those containing pendant moieties, such as, for example, proteins (e.g., nucleases, toxins, antibodies, signal peptides, poly-L-lysine, etc.), those with intercalators (e.g., acridine, psoralen, etc.), those containing chelators (e.g., metals, radioactive metals, boron, oxidative metals, etc.), those containing alkylators, those with modified linkages (e.g., alpha anomeric nucleic acids, etc.), as well as unmodified forms of the polynucleotide(s). Further, any of the hydroxyl groups ordinarily present in the sugars may be replaced, for example, by phosphonate groups, phosphate groups, protected by standard protecting groups, or activated to prepare additional linkages to additional nucleotides, or may be conjugated to solid supports. The 5′ and 3′ terminal OH can be phosphorylated or substituted with amines or organic capping group moieties of from 1 to 20 carbon atoms. Other hydroxyls may also be derivatized to standard protecting groups. Polynucleotides can also contain analogous forms of ribose or deoxyribose sugars that are generally known in the art, including, for example, 2′-O-methyl-, 2′-O-allyl, 2′-fluoro- or 2′-azido-ribose, carbocyclic sugar analogs, alpha- or beta-anomeric sugars, epimeric sugars such as arabinose, xyloses or lyxoses, pyranose sugars, furanose sugars, sedoheptuloses, acyclic analogs and abasic nucleoside analogs such as methyl riboside. One or more phosphodiester linkages may be replaced by alternative linking groups. These alternative linking groups include, but are not limited to, embodiments wherein phosphate is replaced by P(O)S(“thioate”), P(S)S (“dithioate”), (O)NR₂ (“amidate”), P(O)R, P(O)OR′, CO or CH₂ (“formacetal”), in which each R or R′ is independently H or substituted or unsubstituted alkyl (1-20 C) optionally containing an ether (—O—) linkage, aryl, alkenyl, cycloalkyl, cycloalkenyl or araldyl. Not all linkages in a polynucleotide need be identical. The preceding description applies to all polynucleotides referred to herein, including RNA and DNA.

A “variable region” of an antibody refers to the variable region of the antibody light chain or the variable region of the antibody heavy chain, either alone or in combination. The variable regions of the heavy and light chain each consist of four framework regions (FR) connected by three complementarity determining regions (CDRs) also known as hypervariable regions. The CDRs in each chain are held together in close proximity by the FRs and, with the CDRs from the other chain, contribute to the formation of the antigen-binding site of antibodies. There are at least two techniques for determining CDRs: (1) an approach based on cross-species sequence variability (i.e., Kabat et al. Sequences of Proteins of Immunological Interest, (5th ed., 1991, National Institutes of Health, Bethesda Md.)); and (2) an approach based on crystallographic studies of antigen-antibody complexes (Al-lazikani et al (1997) J. Molec. Biol. 273:927-948)). As used herein, a CDR may refer to CDRs defined by either approach or by a combination of both approaches.

A “constant region” of an antibody refers to the constant region of the antibody light chain or the constant region of the antibody heavy chain, either alone or in combination.

As used herein, “immunospecific” binding of antibodies refers to the antigen specific binding interaction that occurs between the antigen-combining site of an antibody and the specific antigen recognized by that antibody (i.e., the antibody reacts with the protein in an ELISA or other immunoassay, and does not react detectably with unrelated proteins).

An epitope that “preferentially binds” or “specifically binds” (used interchangeably herein) to an antibody or a polypeptide is a term well understood in the art, and methods to determine such specific or preferential binding are also well known in the art. A molecule is said to exhibit “specific binding” or “preferential binding” if it reacts or associates more frequently, more rapidly, with greater duration and/or with greater affinity with a particular cell or substance than it does with alternative cells or substances. An antibody “specifically binds” or “preferentially binds” to a target if it binds with greater affinity, avidity, more readily, and/or with greater duration than it binds to other substances. For example, an antibody that specifically or preferentially binds to a CGRP epitope is an antibody that binds this epitope with greater affinity, avidity, more readily, and/or with greater duration than it binds to other CGRP epitopes or non-CGRP epitopes. It is also understood by reading this definition that, for example, an antibody (or moiety or epitope) that specifically or preferentially binds to a first target may or may not specifically or preferentially bind to a second target. As such, “specific binding” or “preferential binding” does not necessarily require (although it can include) exclusive binding. Generally, but not necessarily, reference to binding means preferential binding.

As used herein, “substantially pure” refers to material which is at least 50% pure (i.e., free from contaminants), more preferably at least 90% pure, more preferably at least 95% pure, more preferably at least 98% pure, more preferably at least 99% pure.

A “host cell” includes an individual cell or cell culture that can be or has been a recipient for vector(s) for incorporation of polynucleotide inserts. Host cells include progeny of a single host cell, and the progeny may not necessarily be completely identical (in morphology or in genomic DNA complement) to the original parent cell due to natural, accidental, or deliberate mutation. A host cell includes cells transfected with a polynucleotide(s) of this invention.

The term “Fc region” is used to define a C-terminal region of an immunoglobulin heavy chain. The “Fc region” may be a native sequence Fc region or a variant Fc region. Although the boundaries of the Fc region of an immunoglobulin heavy chain might vary, the human IgG heavy chain Fc region is usually defined to stretch from an amino acid residue at position Cys226, or from Pro230, to the carboxyl-terminus of the heavy chain. The numbering of the residues in the Fc region is that of the EU index as in Kabat. Kabat et al., Sequences of Proteins of Imunological Interest, 5th Ed. Public Health Service, National Institutes of Health, Bethesda, Md., 1991. The Fc region of an immunoglobulin generally comprises two constant domains, CH2 and CH3.

As used herein, “Fc receptor” and “FcR” describe a receptor that binds to the Fc region of an antibody. The preferred FcR is a native sequence human FcR. Moreover, a preferred FcR is one which binds an IgG antibody (a gamma receptor) and includes receptors of the FcγRI, FcγRII, and FcγRIII subclasses, including allelic variants and alternatively spliced forms of these receptors. FcγRII receptors include FcγRIIA (an “activating receptor”) and FcγRIIB (an “inhibiting receptor”), which have similar amino acid sequences that differ primarily in the cytoplasmic domains thereof. FcRs are reviewed in Ravetch and Kinet, 1991, Ann. Rev. Immunol., 9:457-92; Capel et al., 1994, Immunomethods, 4:25-34; and de Haas et al., 1995, J. Lab. Clin. Med., 126:330-41. “FcR” also includes the neonatal receptor, FcRn, which is responsible for the transfer of maternal IgGs to the fetus (Guyer et al., 1976, J. Immunol., 117:587; and Kim et al., 1994, J. Immunol., 24:249).

“Complement dependent cytotoxicity” and “CDC” refer to the lysing of a target in the presence of complement. The complement activation pathway is initiated by the binding of the first component of the complement system (Clq) to a molecule (e.g. an antibody) complexed with a cognate antigen. To assess complement activation, a CDC assay, e.g. as described in Gazzano-Santoro et al., J. Immunol. Methods, 202:163 (1996), may be performed.

A “functional Fc region” possesses at least one effector function of a native sequence Fc region. Exemplary “effector functions” include Clq binding; complement dependent cytotoxicity (CDC); Fc receptor binding; antibody-dependent cell-mediated cytotoxicity (ADCC); phagocytosis; down-regulation of cell surface receptors (e.g. B cell receptor; BCR), etc. Such effector functions generally require the Fc region to be combined with a binding domain (e.g. an antibody variable domain) and can be assessed using various assays known in the art for evaluating such antibody effector functions.

A “native sequence Fc region” comprises an amino acid sequence identical to the amino acid sequence of an Fc region found in nature. A “variant Fc region” comprises an amino acid sequence which differs from that of a native sequence Fc region by virtue of at least one amino acid modification, yet retains at least one effector function of the native sequence Fc region. Preferably, the variant Fc region has at least one amino acid substitution compared to a native sequence Fc region or to the Fc region of a parent polypeptide, e.g. from about one to about ten amino acid substitutions, and preferably from about one to about five amino acid substitutions in a native sequence Fc region or in the Fc region of the parent polypeptide. The variant Fc region herein will preferably possess at least about 80% sequence identity with a native sequence Fc region and/or with an Fc region of a parent polypeptide, and most preferably at least about 90% sequence identity therewith, more preferably at least about 95%, at least about 96%, at least about 97%, at least about 98%, at least about 99% sequence identity therewith.

As used herein “antibody-dependent cell-mediated cytotoxicity” and “ADCC” refer to a cell-mediated reaction in which nonspecific cytotoxic cells that express Fc receptors (FcRs) (e.g. natural killer (NK) cells, neutrophils, and macrophages) recognize bound antibody on a target cell and subsequently cause lysis of the target cell. ADCC activity of a molecule of interest can be assessed using an in vitro ADCC assay, such as that described in U.S. Pat. No. 5,500,362 or 5,821,337. Useful effector cells for such assays include peripheral blood mononuclear cells (PBMC) and NK cells. Alternatively, or additionally, ADCC activity of the molecule of interest may be assessed in vivo, e.g., in an animal model such as that disclosed in Clynes et al., 1998, PNAS (USA), 95:652-656.

As used herein, “treatment” is an approach for obtaining beneficial or desired clinical results. For purposes of this invention, beneficial or desired clinical results include, but are not limited to, one or more of the following: improvement in any aspect of visceral pain including lessening severity, alleviation of pain intensity, and other associated symptoms, reducing frequency of recurrence, increasing the quality of life of those suffering from the visceral pain, and decreasing dose of other medications required to treat the visceral pain. Other associated symptoms include, but are not limited to, cramps, aches, diffuse pain, pressure, fullness, squeezing, nausea, vomiting, and sensitivity to light, sound, and/or movement.

“Reducing incidence” of visceral pain means any of reducing severity (which can include reducing need for and/or amount of (e.g., exposure to) other drugs and/or therapies generally used for this condition, including, for example, opiates (e.g., oxycodone, morphine, butorphanol, nalbuphine, etc.), duration, and/or frequency. As is understood by those skilled in the art, individuals may vary in terms of their response to treatment, and, as such, for example, a “method of reducing incidence of visceral pain in an individual” reflects administering the anti-CGRP antagonist antibody based on a reasonable expectation that such administration may likely cause such a reduction in incidence in that particular individual.

“Ameliorating” visceral pain and/or a symptom associated with visceral pain means a lessening or improvement of one or more symptoms of visceral pain and/or symptoms associated with visceral pain as compared to not administering an anti-CGRP antagonist antibody. “Ameliorating” also includes shortening or reduction in duration of a symptom.

“Palliating” visceral pain and/or a symptom associated with visceral pain means lessening the extent of one or more undesirable clinical manifestations of visceral pain in an individual or population of individuals treated with an anti-CGRP antagonist antibody in accordance with the invention.

As used herein, “controlling visceral pain” refers to maintaining or reducing severity or duration of one or more symptoms of visceral pain or frequency of visceral pain as compared to the level before treatment. For example, the duration or severity of visceral pain, or frequency of visceral pain, can be reduced by at least about any of 10%, 20%, 30%, 40%, 50%, 60%, or 70% in the individual as compared to the level before treatment.

As used therein, “delaying” the development of visceral pain means to defer, hinder, slow, retard, stabilize, and/or postpone progression of the visceral pain. This delay can be of varying lengths of time, depending on the history of the disease and/or individuals being treated. As is evident to one skilled in the art, a sufficient or significant delay can, in effect, encompass prevention, in that the individual does not develop visceral pain. A method that “delays” development of the symptom is a method that reduces probability of developing the symptom in a given time frame and/or reduces extent of the symptoms in a given time frame, when compared to not using the method. Such comparisons are typically based on clinical studies, using a number of subjects sufficient to show a statistically significant difference between treated and untreated subjects.

“Development” or “progression” of visceral pain means initial manifestations and/or ensuing progression of the disorder. Development of visceral pain can be detectable and assessed using standard clinical techniques as well known in the art. However, development also refers to progression that may be undetectable. For purpose of this invention, development or progression refers to the biological course of the symptoms. “Development” includes occurrence, recurrence, and onset. As used herein “onset” or “occurrence” of visceral pain includes initial onset and/or recurrence.

A “biological sample” encompasses a variety of sample types obtained from an individual and can be used in a diagnostic or monitoring assay. The definition encompasses blood and other liquid samples of biological origin, solid tissue samples such as a biopsy specimen or tissue cultures or cells derived therefrom, and the progeny thereof. The definition also includes samples that have been manipulated in any way after their procurement, such as by treatment with reagents, solubilization, or enrichment for certain components, such as proteins or polynucleotides, or embedding in a semi-solid or solid matrix for sectioning purposes. The term “biological sample” encompasses a clinical sample, and also includes cells in culture, cell supernatants, cell lysates, serum, plasma, biological fluid, and tissue samples.

As used herein, an “effective dosage” or “effective amount” of drug, compound, or pharmaceutical composition is an amount sufficient to effect beneficial or desired results. For prophylactic use, beneficial or desired results include results such as eliminating or reducing the risk, lessening the severity, or delaying the outset of the disease, including biochemical, histological and/or behavioral symptoms of the disease, its complications and intermediate pathological phenotypes presenting during development of the disease. For therapeutic use, beneficial or desired results include clinical results such as reducing pain intensity, duration, or frequency of visceral pain attack, and decreasing one or more symptoms resulting from visceral pain (biochemical, histological and/or behavioral), including its complications and intermediate pathological phenotypes presenting during development of the pain, increasing the quality of life of those suffering from the pain, decreasing the dose of other medications required to treat the pain, enhancing effect of another medication, and/or delaying the progression of the pain of patients. An effective dosage can be administered in one or more administrations. For purposes of this invention, an effective dosage of drug, compound, or pharmaceutical composition is an amount sufficient to accomplish prophylactic or therapeutic treatment either directly or indirectly. As is understood in the clinical context, an effective dosage of a drug, compound, or pharmaceutical composition may or may not be achieved in conjunction with another drug, compound, or pharmaceutical composition. Thus, an “effective dosage” may be considered in the context of administering one or more therapeutic agents, and a single agent may be considered to be given in an effective amount if, in conjunction with one or more other agents, a desirable result may be or is achieved.

An “individual” or a “subject” is a mammal, more preferably a human. Mammals also include, but are not limited to, farm animals, sport animals, pets, primates, horses, dogs, cats, mice and rats.

As used herein, “vector” means a construct, which is capable of delivering, and preferably expressing, one or more gene(s) or sequence(s) of interest in a host cell. Examples of vectors include, but are not limited to, viral vectors, naked DNA or RNA expression vectors, plasmid, cosmid or phage vectors, DNA or RNA expression vectors associated with cationic condensing agents, DNA or RNA expression vectors encapsulated in liposomes, and certain eukaryotic cells, such as producer cells.

As used herein, “expression control sequence” means a nucleic acid sequence that directs transcription of a nucleic acid. An expression control sequence can be a promoter, such as a constitutive or an inducible promoter, or an enhancer. The expression control sequence is operably linked to the nucleic acid sequence to be transcribed.

As used herein, “pharmaceutically acceptable carrier” or “pharmaceutical acceptable excipient” includes any material which, when combined with an active ingredient, allows the ingredient to retain biological activity and is non-reactive with the subject's immune system. Examples include, but are not limited to, any of the standard pharmaceutical carriers such as a phosphate buffered saline solution, water, emulsions such as oil/water emulsion, and various types of wetting agents. Preferred diluents for aerosol or parenteral administration are phosphate buffered saline or normal (0.9%) saline. Compositions comprising such carriers are formulated by well known conventional methods (see, for example, Remington's Pharmaceutical Sciences, 18th edition, A. Gennaro, ed., Mack Publishing Co., Easton, Pa., 1990; and Remington, The Science and Practice of Pharmacy 20th Ed. Mack Publishing, 2000).

The term “k_(on)”, as used herein, is intended to refer to the rate constant for association of an antibody to an antigen.

The term “k_(off)”, as used herein, is intended to refer to the rate constant for dissociation of an antibody from the antibody/antigen complex.

The term “K_(D)”, as used herein, is intended to refer to the equilibrium dissociation constant of an antibody-antigen interaction.

Methods for Preventing or Treating Visceral Pain

Disclosed herein are methods for the prevention and/or treatment of visceral pain and/or symptoms of visceral pain and a medicament for prevention and/or treatment of visceral pain and/or one or more symptoms of visceral pain in an individual.

In some embodiments, the invention provides a method of preventing and/or treating visceral pain and/or one or more symptoms of visceral pain in an individual, comprising peripheral administration to the individual of an effective amount of an anti-CGRP antagonist antibody.

In other embodiments, the invention provides a method of ameliorating, controlling, reducing incidence of, or delaying the development or progression of visceral pain and/or one or more symptoms of visceral pain in an individual, comprising peripheral administration to the individual of an effective amount of an anti-CGRP antagonist antibody.

In some embodiments, the invention provides the use of an anti-CGRP antagonist antibody for the manufacture of a medicament for the prevention and/or treatment of visceral pain and/or one or more symptoms of visceral pain, wherein the medicament is prepared for peripheral administration or wherein the medicament is administered peripherally.

In other embodiments, the invention provides an anti-CGRP antagonist antibody for use in the prevention and/or treatment of visceral pain and/or symptoms of visceral pain wherein the antibody is prepared for peripheral administration or wherein the antibody is administered peripherally.

In other embodiments, the invention provides the use of an anti-CGRP antagonist antibody for the manufacture of a medicament for ameliorating, controlling, reducing incidence of, or delaying the development or progression of visceral pain and/or symptoms of visceral pain, wherein the medicament is prepared for peripheral administration or wherein the medicament is administered peripherally.

In some embodiments, the individual is preferably a mammal, for example a companion animal such as a horse, cat or dog or a farm animal such as a sheep, cow or pig. Most preferably the mammal is a human.

In some embodiments, the medicament and/or anti-CGRP antagonist antibody is prepared for oral, sublingual, buccal, topical, rectal, inhalation, transdermal, subcutaneous, intravenous, intra-arterial, intramuscular, intracardiac, intraosseous, intradermal, intraperitoneal, transmucosal, vaginal, intravitreal, intra-articular, peri-articular, central, local or epicutaneous administration.

In some embodiments, the medicament is prepared for peripheral administration prior to and/or during and/or after the development of visceral pain.

In some embodiments, the anti-CGRP antagonist antibody acts peripherally on administration. In one embodiment, the anti-CGRP antagonist antibody is not administered centrally, spinally or intrathecally.

In some embodiments, the visceral pain is associated with and/or caused by a disease such as, for example, a functional bowel disorder (FBD) or inflammatory bowel disease (IBD). In embodiments where the visceral pain is associated with FBD, the FBD may be, for example without limitation, gastro-esophageal reflux, dyspepsia, irritable bowel syndrome (IBS) or functional abdominal pain syndrome (FAPS). Most preferably, the disease is IBS. In embodiments where the visceral pain is associated with IBD, the IBD may be, for example without limitation, Crohn's disease, ileitis or ulcerative colitis. Other types of visceral pain include the pain associated with, for example, cancer, renal colic, dysmenorrhea, cystitis, including interstitial cystitis (IC), surgery associated with the ileus, menstrual period, labor, menopause, bone fracture, diverticulitis, peritonitis, pericarditis, hepatitis, appendicitis, colitis, cholecystitis, endometriosis, chronic and/or acute pancreatitis, myocardial infarction, kidney pain, pleural pain, prostatitis, pelvic pain, and trauma to an organ.

In some embodiments, the methods and uses of the invention may be for amerliorating visceral pain and/or one or more symptoms associated with visceral pain in an individual having FBD, IBD or IC.

Diagnosis or assessment of visceral pain is well-established in the art. Assessment may be performed based on measures known in the art, such as patient characterization of pain using various pain scales. See, e.g., Katz et al, Surg Clin North Am., 1999, 79 (2):231-52; Caraceni et al. J Pain Symptom Manage, 2002, 23(3):239-55. For example, the verbal descriptor scale (VDS), the visual analog scale (VAS), the Prince Henry Hospital Pain Scale (PHHPS), the numeric rating scale (NRS), and the Faces Pain Scale, and variations thereof, may be employed to assess pain and evaluate response to the treatment. There are also commonly used scales to measure disease state such as the Functional Bowel Disorder Severity Index (FBDSI) (Drossman et al., 1995, Digestive Diseases and Sciences 40(5):986-995) and the IBS Severity Scoring System (Francis et al., 1997, Aliment Pharmacol Ther., 11(2):395-402). Such scales may be employed to evaluate response to the treatment.

In some embodiments, ameliorating, controlling, reducing incidence of, or delaying the development or progression of FBD pain and/or symptoms of FBD pain is measured by one or more of the FBDSI, VDS, VAS, PHHPS, NRS and Faces Pain Scale. In another embodiment, ameliorating, controlling, reducing incidence of, or delaying the development or progression of IBS pain and/or symptoms of IBS pain is measured by one or more of the IBS Severity Scoring System, VDS, VAS, PHHPS, NRS and Faces Pain Scale.

In some embodiments, ameliorating, controlling, reducing incidence of, or delaying the development or progression of IC pain and/or symptoms of IC pain is measured by one or more of the VDS, VAS, PHHPS, NRS and Faces Pain Scale.

Anti-CGRP Antagonist Antibodies

In some embodiments, the anti-CGRP antagonist antibody binds to CGRP. Preferably, the anti-CGRP antagonist antibody binds to CGRP and inhibits the ability of CGRP to bind to the CGRP receptor. In some embodiments, the anti-CGRP antagonist antibody binds to both human and rodent CGRP, preferably human and rat CGRP. More preferably, the antibody binds to human CGRP. In preferred embodiments, the anti-CGRP antagonist antibody binds to human α-CGRP or to human α-CGRP and/or β-CGRP. Most preferably, the anti-CGRP antagonist antibody is an antibody that exhibits any one or more of the following functional characteristics: (a) binds to CGRP; (b) blocks CGRP from binding to its receptor(s); (c) blocks or decreases CGRP receptor activation, including cAMP activation; (d) inhibits, blocks, suppresses or reduces CGRP biological activity, including downstream pathways mediated by CGRP signalling, such as receptor binding and/or elicitation of a cellular response to CGRP; (e) prevents, ameliorates, or treats any aspect of visceral pain; (f) increases clearance of CGRP; and (g) inhibits (reduces) CGRP synthesis, production or release.

In some embodiments, the anti-CGRP antagonist antibody binds to a fragment of CGRP, more preferably to a fragment of CGRP as well as to the full length CGRP. Preferably, the anti-CGRP antagonist antibody binds to the C-terminal region or fragment of CGRP. The C-terminal region or fragment of CGRP preferably comprises amino acids 19-37 or 25-37 or 29-37, or, alternatively, amino acids 30-37, or, further alternatively, amino acids 31-37 of CGRP. In a further embodiment, the C-terminal region or fragment of CGRP preferably comprises amino acids 32-37, most preferably amino acids 33-37 of CGRP. Preferably, the CGRP is either α-CGRP or β-CGRP, further preferably human or rodent, further preferably human or rat, more preferably human, further preferably human α-CGRP or β-CGRP, most preferably human α-CGRP.

In some embodiments, the anti-CGRP antagonist antibody specifically binds to the amino acid sequence GSKAF (SEQ ID NO: 39). Preferably the sequence GSKAF (SEQ ID NO: 39) of CGRP is the epitope to which the anti-CGRP antagonist antibody binds.

In some embodiments, an anti-CGRP antagonist antibody is provided which specifically binds to an epitope defined by amino acids G33 to F37 of CGRP. The anti-CGRP antagonist antibody may specifically bind to the epitope defined by the amino acid sequence GSKAF (SEQ ID NO: 39). In some embodiments, the present invention provides the use of such an antibody in the uses and methods defined in the various aspects of the present invention.

In some embodiments, the anti-CGRP antagonist antibody inhibits or prevents activation of the CGRP receptor. Preferably the anti-CGRP antibody has an IC50 of between about 0.0001 (0.1 nM) to about 500 μM. In some preferred embodiments, the IC50 is between about 0.0001 μM □ and any of about 250 μM, 100 μM, 50 μM, 10 μM, 1 μM, 500 nM, 250 nM, 100 nM, 50 nM, 20 nM, 15 nM, 10 nM, 5 nM, 1 nM, or 0.5 nM as measured in an in vitro binding assay. In some further preferred embodiments, IC50 is less than any of about 500 μM, or about 100 μM, or about 50 μM, as measured in an in vitro binding assay. In a further more preferred embodiment IC50 is about 1.2 nM or 31 nM.

In some embodiments, the anti-CGRP antagonist antibody used is capable of competing with an antibody herein above described for the binding of CGRP or to a fragment of CGRP, or to a fragment of CGRP as well as the full length CGRP, preferably to the C-terminal region or fragment of CGRP. In preferred embodiments, the C-terminal region or fragment of CGRP comprises amino acids 19-37, 25-37, 29-37, 30-37, or 31-37 of CGRP. In a further embodiment, the C-terminal region or fragment of CGRP preferably comprises amino acids 32-37, most preferably 33-37, of CGRP.

In some embodiments, the anti-CGRP antagonist antibody binds to CGRP, a region of CGRP, or a fragment of CGRP with a binding affinity (K_(D)) of between about 0.00001 μM (0.01 nM) to about 500 μM. In some embodiments, the binding affinity (K_(D)) is between about 0.00001 μM □ and any of about 250 μM, 100 μM, 50 μM, 10 μM, 1 μM, 500 nM, 250 nM, 100 nM, 50 nM, 20 nM, 15 nM, 10 nM, 5 nM, 1 nM, 0.5 nM, 1 nM, 0.05 nM, or 0.01 nM as measured in an in vitro binding assay. In some embodiments, the binding affinity (K_(D)) is less than any of about 500 μM, or 100 μM, 50 μM, or 10 μM, as measured in an in vitro binding assay. In further more preferred embodiments, binding affinity (K_(D)) is about 0.04 nM or 16 nM.

The anti-CGRP antagonist antibody as used in the present invention may be selected from the group of: monoclonal antibodies, polyclonal antibodies, antibody fragments (e.g., Fab, Fab′, F(ab′)₂, Fv, Fc, ScFv etc.), chimeric antibodies, bispecific antibodies, heteroconjugate antibodies, single chain (ScFv) antibodies, mutants thereof, fusion proteins comprising an antibody portion (e.g., a domain antibody), humanized antibodies, and any other modified configuration of the immunoglobulin molecule that comprises an antigen recognition site of the required specificity, including glycosylation variants of antibodies, amino acid sequence variants of antibodies, and covalently modified antibodies. The anti-CGRP antagonist antibody may be murine, rat, human, or any other origin (including chimeric or humanized antibodies). In some embodiments, the anti-CGRP antagonist antibody may be humanized but is more preferably human. In some embodiments, the anti-CGRP antagonist antibody is isolated. In some embodiments, the anti-CGRP antagonist antibody is substantially pure. Where the anti-CGRP antagonist antibody is an antibody fragment, the fragment preferably retains the functional characteristics of the original antibody, i.e., the CGRP binding and/or antagonist activity as described in the functional characteristics above.

Examples of anti-CGRP antagonist antibodies are known in the art. Hence, according to a preferred embodiment of the present invention the anti-CGRP antagonist antibody as used in the present invention is preferably an anti-CGRP antibody as generally or specifically disclosed in any of (i) WO2007/054809, (ii) WO2007/076336, (iii) Tan et al., Clin. Sci. (Lond). 89:565-73, 1995, (iv) Sigma (Missouri, US), product number C7113 (clone #4901), (v) Plourde et al., Peptides 14:1225-1229, 1993, or which comprises or consists of:

(a) a fragment of said antibody (e.g., Fab, Fab′, F(ab′)2, Fv, Fc, ScFv etc.),

(b) a light chain of said antibody,

(c) a heavy chain of said antibody,

(d) one or more variable region(s) from a light chain and/or a heavy chain of said antibody,

(e) one or more CDR(s) (one, two, three, four, five or six CDRs) of said antibody,

(f) CDR H3 from the heavy chain of said antibody,

(g) CDR L3 from the light chain of said antibody,

(h) three CDRs from the light chain of said antibody,

(i) three CDRs from the heavy chain of said antibody,

(j) three CDRs from the light chain and three CDRs from the heavy chain, of said antibody,

(k) any one or more of (a) through (j).

In some embodiments, the anti-CGRP antagonist antibody is antibody G2 or antibody G1. According to a most preferred embodiment of the present the anti-CGRP antagonist antibody used is the anti-CGRP antibody G1 as specifically disclosed in PCT Patent Application Pub. No. WO2007/054809, or comprising its variants shown in Table 6 of WO2007/054809, also including functionally equivalent antibodies to G1, i.e., comprising conservative substitutions of amino acid residues or one or more deletions or additions of amino acids which do not significantly affect their functional characteristics e.g. CGRP binding or antagonist activity and variants which have enhanced or decreased activity and/or binding. As used herein, the terms “G1” and “antibody G1” are used interchangeably to refer to an antibody produced by expression vectors having deposit numbers of ATCC PTA-6867 and ATCC PTA-6866 as disclosed in application WO2007/054809. Functional characteristics of antibody G1 are described in PCT Patent Application Nos. PCT/IB2009/050849 and PCT/IB2009/050852, both filed Mar. 3, 2009, and incorporated herein by reference in their entireties.

According to a further embodiment of the present invention, the anti-CGRP antagonist antibody comprises or consists of a polypeptide selected from: (a) antibody G1 or its variants shown in Table 6 of WO2007/054809; (b) a fragment or a region of antibody G1 or its variants shown in Table 6 of WO2007/054809; (c) a light chain of antibody G1 or its variants shown in Table 6 of WO2007/054809; (d) a heavy chain of antibody G1 or its variants shown in Table 6 of WO2007/054809 (e) one or more variable region(s) from a light chain and/or a heavy chain of antibody G1 or its variants shown in Table 6 of WO2007/054809; (f) one or more CDR(s) (one, two, three, four, five or six CDRs) of antibody G1 or its variants shown in Table 6 of WO2007/054809; (g) CDR H3 from the heavy chain of antibody G1 or its variants shown in Table 6 of WO2007/054809; (h) CDR L3 from the light chain of antibody G1 or its variants shown in Table 6 of WO2007/054809; (i) three CDRs from the light chain of antibody G1 or its variants shown in Table 6 of WO2007/054809; (j) three CDRs from the heavy chain of antibody G1 or its variants shown in Table 6 of WO2007/054809; (k) three CDRs from the light chain and/or three CDRs from the heavy chain, of antibody G1 or its variants shown in Table 6 of WO2007/054809; and (i) an antibody comprising any one of (b) through (k). The invention also provides polypeptides comprising any one or more of the above. In some embodiments, the at least one, two, three, four, five, or six CDR(s) are at least about 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% identical to at least one, two, three, four, five or six CDRs of G1 or its variants shown in Table 6 of WO2007/054809. Determination of CDR regions is well within the ability of the skilled person. It is understood that in some embodiments, CDRs can be a combination of the Kabat and Chothia CDR. In some embodiments, the CDRs are the Kabat CDRs. In other embodiments, the CDRs are the Chothia CDRs.

The anti-CGRP antagonist antibody preferably comprises or consists of a fragment or a region of the antibody G1 (e.g., Fab, Fab′, F(ab′)2, Fv, Fc, ScFv etc.) or its variants shown in Table 6 of WO2007/054809. Preferably, said fragment or region has the functional characteristics of an anti-CGRP antagonist antibody such as, for example, CGRP binding activity and/or antagonist activity, and comprises or consists of one or more of: (i) a light chain, (ii) a heavy chain, (iii) a fragment containing one or more variable regions from a light chain and/or a heavy chain, and (iv) one or more CDRs from a light chain and/or a heavy chain of the antibody G1.

In some embodiments, the anti-CGRP antagonist antibody comprises a light chain variable region (LCVR) comprising a peptide with a sequence selected from the group consisting of SEQ ID NOs: 28-32 and/or a heavy chain variable region (HCVR) comprising a peptide with a sequence selected from the group consisting of SEQ ID NOs: 34-38 of patent application WO2007/076336.

Further preferably, the anti-CGRP antagonist antibody comprises an LCVR polypeptide of a SEQ ID NO as shown in Table 1 of patent application WO2007/076336 and further comprises a HCVR polypeptide of a SED ID NO as shown in Table 1 of patent application WO2007/076336.

According to a further embodiment of the invention, the anti-CGRP antagonist antibody used comprises a light chain CDR (CDRL) selected from the group consisting of SEQ ID NOs: 8-13 and/or a heavy chain CDR (CDRH) selected from the group consisting of SEQ ID NOs: 14-22 of patent application WO2007/076336.

Methods of making and isolating the anti-CGRP antagonist antibodies of application WO2007/076336 and data demonstrating the CGRP binding and antagonist characterisation of the same are described in application WO2007/076336.

In some embodiments, the anti-CGRP antagonist antibody for use in the present invention comprises a VH domain that is at least about 85%, at least about 86%, at least about 87%, at least about 88%, at least about 89%, at least about 90%, at least about 91%, at least about 92%, at least about 93%, at least about 94%, at least about 95%, at least about 96%, at least about 97% at least about 98%, at least about 99% or 100% identical in amino acid sequence to SEQ ID NO: 1 or SEQ ID NO: 19 presented herein.

In some embodiments, the anti-CGRP antagonist antibody comprises a VL domain that is at least about 85%, at least about 86%, at least about 87%, at least about 88%, at least about 89%, at least about 90%, at least about 91%, at least about 92%, at least about 93%, at least about 94%, at least about 95%, at least about 96%, at least about 97% at least about 98%, at least about 99% or 100% identical in amino acid sequence to SEQ ID NO: 2 or SEQ ID NO: 20 presented herein.

In some embodiments, the anti-CGRP antagonist antibody comprises a VH domain and a VL domain that are at least about 85%, at least about 86%, at least about 87%, at least about 88%, at least about 89%, at least about 90%, at least about 91%, at least about 92%, at least about 93%, at least about 94%, at least about 95%, at least about 96%, at least about 97% at least about 98%, at least about 99% or 100% identical in amino acid sequence to SEQ ID NO: 1 and 2 respectively or SEQ ID NO: 19 and 20 presented herein, respectively.

In some embodiments, the anti-CGRP antagonist antibody comprises a VH domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 1 and a VL domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 2 presented herein.

Alternatively, the anti-CGRP antagonist antibody can comprise a VH domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 19 and a VL domain that is at least 90% identical in amino acid sequence to SEQ ID NO: 20 presented herein.

In some embodiments, the anti-CGRP antagonist antibody comprises at least one CDR selected from the group consisting of: (a). CDR H1 as set forth in SEQ ID NO: 3, 21, 33, 34, 36 or 37; (b). CDR H2 as set forth in SEQ ID NO: 4, 22, 35 or 38; (c). CDR H3 as set forth in SEQ ID NO: 5 or 23; (d). CDR L1 as set forth in SEQ ID NO: 6 or 24; (e) CDR L2 as set forth in SEQ ID NO: 7 or 25; (f). CDR L3 as set forth in SEQ ID NO: 8 or 26; and (g). variants of CDR L1, CDR L2 and CDR H2 as shown in Table 6 of WO2007/054809.

In some embodiments, the anti-CGRP antagonist antibody heavy chain constant region may be from any types of constant region, such as IgG, IgM, IgD, IgA, and IgE; and any isotypes, such as IgGI, IgG2, IgG3, and IgG4.

In some embodiments, the anti-CGRP antagonist antibody comprises a heavy chain produced by the expression vector with ATCC Accession No. PTA-6867. Further preferably the anti-CGRP antagonist antibody comprises a light chain produced by the expression vector with ATCC Accession No. PTA-6866. In some embodiments, the anti-CGRP antagonist antibody comprises the antibody G1 heavy chain full antibody amino acid sequence (including modified IgG2 as described herein) shown in SEQ ID NO: 11, with or without the C-terminal lysine. The anti-CGRP antagonist antibody also includes an antibody lacking a terminal lysine on the heavy chain, as this is normally lost in a proportion of antibodies during manufacture. In some embodiments, the anti-CGRP antagonist antibody comprises the antibody G1 light chain full antibody amino acid sequence shown in SEQ ID NO: 12. In some embodiments, the anti-CGRP antagonist antibody comprises the antibody G2 heavy chain full antibody amino acid sequence shown in SEQ ID NO: 29. In some embodiments, the anti-CGRP antagonist antibody comprises the antibody G2 light chain full antibody amino acid sequence shown in SEQ ID NO: 30. In some embodiments, the anti-CGRP antagonist antibody is produced by the expression vectors with ATCC Accession Nos. PTA-6867 and PTA-6866.

In some embodiments, the anti-CGRP antagonist antibody for use in the present invention is antibody G1 or antibody G2 defined herein. In preferred embodiments, the anti-CGRP antagonist antibody for use in the present invention is antibody G1, or an antigen binding fragment thereof.

According to further embodiments of the invention, the anti-CGRP antagonist antibody comprises a modified constant region as for example described in WO2007/054809. Preferably, the modified constant region is immunologically inert, including partially immunologically inert, such that it does not trigger complement mediated lysis, does not stimulate antibody-dependent cell mediated cytotoxicity (ADCC), does not activate microglia. Preferably, the modified constant region is reduced in one or more of these activities. Most preferably, the constant region is modified as described in Eur. J. Immunol., 1999, 29:2613-2624; PCT Application No. PCT/GB99/01441; and/or UK Patent Application No. 9809951.8. In some embodiments, the anti-CGRP antagonist antibody comprises a human heavy chain IgG2 constant region comprising the following mutations: A330, P331 to S330, S331 (amino acid numbering with reference to the wildtype IgG2 sequence). Eur. J. Immunol., 1999, 29:2613-2624.

Methods of making and isolating the anti-CGRP antagonist antibodies of application WO2007/054809 and data demonstrating the CGRP binding and antagonist characterisation of the same are described in application WO2007/054809. Sequences of SEQ ID NO: 1 to 14 of said application are provided herein as SEQ ID NO: 1 to 14, respectively.

Dosage and Administration

In some embodiments, the anti-CGRP antagonist antibody is peripherally administered between, for example, about once to about 7 times per week, further preferably between about once to about four times per month, further preferably between about once to about six times per 6 month period, further preferably about once to about twelve times per year. Preferably, the anti-CGRP antagonist antibody is peripherally administered in a period selected from: about once daily, once every two, three, four, five or six days, weekly, once every two weeks, once every three weeks, monthly, once every two months, once every three months, once every four months, once every five months, once every six months, once every seven months, once every eight months, once every nine months, once every ten months, once every eleven months or yearly. According to preferred embodiments, the anti-CGRP antagonist antibody is administered via a route selected from one or more of: orally, sublingually, buccally, topically, rectally, via inhalation, transdermally, subcutaneously, intravenously, intra-arterially or intramuscularly, via intracardiac administration, intraosseously, intradermally, intraperitoneally, transmucosally, vaginally, intravitreally, epicutaneously, intra-articularly, peri-articularly or locally.

According to a further embodiment of the present invention, the medicament is prepared for peripheral administration between about once to about 7 times per week, further preferably between about once to about four times per month, further preferably between about once to about six times per 6 month period, further preferably about once to about twelve times per year. Preferably, the medicament is prepared to be peripherally administered in a period selected from: about once daily, once every two, three, four, five or six days, weekly, once every two weeks, once every three weeks, monthly, once every two months, once every three months, once every four months, once every five months, once every six months, once every seven months, once every eight months, once every nine months, once every ten months, once every eleven months or yearly. According to preferred embodiments, the medicament is prepared to be peripherally administered via a route selected from one or more of: orally, sublingually, buccally, topically, rectally, via inhalation, transdermally, subcutaneously, intravenously, intra-arterially or intramuscularly, via intracardiac administration, intraosseously, intradermally, intraperitoneally, transmucosally, vaginally, intravitreally, epicutaneously, intra-articularly, peri-articularly or locally.

According to a further embodiment of the present invention, an antibody concentration of between about 0.1 to about 200 mg/ml; preferably at any one of about 0.5, 1, 5, 10, 15 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190 or 200 mg/ml+/−10% error, most preferably at about 50 mg/ml.

According to a further embodiment of the present invention the medicament is prepared for peripheral administration with an antibody concentration of between 0.1 to 200 mg/kg of body weight; preferably at any one of about 0.5, 1, 5, 10,15 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 110, 120, 130, 140, 150, 160, 170, 180, 190 or 200 mg/kg of body weight+/−10% error, most preferably at about 10 mg/kg.

According to a preferred embodiment of the present invention the anti-CGRP antagonist antibody has a half life in-vivo of more than any one of about 2, 4, 6, 8,10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72, 74, 76, 78, 80, 82, 84, 86, 88, 90, 92, 94, 96, 98, 100, 102, 104, 106, 108, 110, 112, 114, 116, 118, 120, 122, 124, 126, 128, 130, 132, 134, 136, 138, 140, 142, 144, 146, 148, 150, 152,154, 156, 158, 160, 62, 164, 166, 168, 170, 172, 174, 176, 178, 180, 182, 184, 186, 188, 190, 192, 194, 196, 198, 200, 202, 204, 206, 208 or 210 days+/−1 day, further preferably more than any one of about 7, 8, 9, 10, 11, or 12 months.

Preferably, the anti-CGRP antagonist antibody has a half life in-vivo of more than 6 days.

According to a further preferred embodiment of the present invention, the medicament and/or the anti-CGRP antagonist antibody does not produce effects of central nervous system and/or cognitive impairment. Preferably the medicament and/or the anti-CGRP antagonist antibody does not induce any one or more of the following: amnesia, confusion, depersonalization, hypesthesia, abnormal thinking, trismus, vertigo, akathisia, apathy, ataxia, circumoral paresthesia, CNS stimulation, emotional lability, euphoria, hallucinations, hostility, hyperesthesia, hyperkinesia, hypotonia, incoordination, libido increase, manic reaction, myoclonus, neuralgia, neuropathy, psychosis, seizure, abnormal speech, stupor, suicidal ideation; dizziness, somnolence, Insomnia, anxiety, tremor, depression or paresthesia. Most preferably the medicament and/or the anti-CGRP antagonist antibody does not induce impairment of motor coordination or attention.

According to a further embodiment of the present invention, the medicament and/or the anti-CGRP antagonist antibody does not produce respiratory, liver renal or gastro-intestinal impairment.

According to a further embodiment of the present invention, the medicament and/or the anti-CGRP antagonist antibody does not produce effects of physical and/or psychological dependence. Preferably the medicament and/or the anti-CGRP antagonist antibody does not demonstrate affinity for opiate, benzodiazepine, phencyclidine (PCP), or N-methyl-D-aspartic acid (NMDA) receptors, or CNS stimulant, or produce any sedating or euphoric effect.

In some embodiments, the anti-CGRP antagonist antibody, on administration, ameliorates, controls, reduces incidence of, or delays the development or progression of central pain sensation.

In other embodiments, the effect of the anti-CGRP antagonist antibody is equal and/or superior to the effects of NSAIDS and/or opiates in the same models of visceral pain. In one embodiment, the anti-CGRP antagonist antibody is effective in treating refractory pain populations.

According to further embodiments of the present invention, there is provided the use or method according to any other aspect of the invention wherein the anti-CGRP antagonist antibody is administered separately, sequentially or simultaneously in combination with one or more further pharmacologically active compounds or agents, preferably compounds or agents useful for treating visceral pain. Preferably, the additional agent(s) is/are selected from one or more of:

(i) an opioid analgesic, e.g. morphine, heroin, hydromorphone, oxymorphone, levorphanol, levallorphan, methadone, meperidine, fentanyl, cocaine, codeine, dihydrocodeine, oxycodone, hydrocodone, propoxyphene, nalmefene, nalorphine, naloxone, naltrexone, buprenorphine, butorphanol, nalbuphine or pentazocine;

(ii) a nonsteroidal antiinflammatory drug (NSAID), e.g. aspirin, diclofenac, diflusinal, etodolac, fenbufen, fenoprofen, flufenisal, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamic acid, mefenamic acid, nabumetone, naproxen, oxaprozin, phenylbutazone, piroxicam, sulindac, tolmetin or zomepirac, cyclooxygenase-2 (COX-2) inhibitors, celecoxib; rofecoxib; meloxicam; JTE-522; L-745,337; NS398;, or a pharmaceutically acceptable salt thereof;

(iii) a barbiturate sedative, e.g. amobarbital, aprobarbital, butabarbital, butabital, mephobarbital, metharbital, methohexital, pentobarbital, phenobartital, secobarbital, talbutal, theamylal or thiopental or a pharmaceutically acceptable salt thereof;

(iv) a benzodiazepine having a sedative action, e.g. chlordiazepoxide, clorazepate, diazepam, flurazepam, lorazepam, oxazepam, temazepam or triazolam or a pharmaceutically acceptable salt thereof;

(v) an H₁ antagonist having a sedative action, e.g. diphenhydramine, pyrilamine, promethazine, chlorpheniramine or chlorcyclizine or a pharmaceutically acceptable salt thereof;

(vi) a sedative such as glutethimide, meprobamate, methaqualone or dichloralphenazone or a pharmaceutically acceptable salt thereof;

(vii) a skeletal muscle relaxant, e.g. baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, methocarbamol or orphrenadine or a pharmaceutically acceptable salt thereof;

(viii) an NMDA receptor antagonist, e.g. dextromethorphan ((+)-3-hydroxy-N-methylmorphinan) or its metabolite dextrorphan ((+)-3-hydroxy-N-methylmorphinan), ketamine, memantine, pyrroloquinoline quinone or cis-4-(phosphonomethyl)-2-piperidinecarboxylic acid or a pharmaceutically acceptable salt thereof;

(ix) an alpha-adrenergic, e.g. doxazosin, tamsulosin, clonidine or 4-amino-6,7-dimethoxy-2-(5-methanesulfonamido-1,2,3,4-tetrahydroisoquinol-2-yl)-5-(2-pyridyl) quinazoline;

(x) a tricyclic antidepressant, e.g. desipramine, imipramine, amytriptiline or nortriptiline;

(xi) an anticonvulsant, e.g. carbamazepine or valproate;

(xii) a tachykinin (NK) antagonist, particularly an NK-3, NK-2 or NK-1 antagonist, e.g. (αR, 9R)-7-[3,5-bis(trifluoromethyl)benzyl]-8,9,10,11-tetrahydro-9-methyl-5-(4-methylphenyl)-7H-[1,4]diazocino[2,1-g][1,7]naphthridine-6-13-dione (TAK-637), 5-[[(2R,3S)-2-[(1R)-1-[3,5-bis(trifluoromethyl)phenyl]ethoxy-3-(4-fluorophenyl)-4-morpholinyl]methyl]-1,2-dihydro-3H-1,2,4-triazol-3-one (MK-869), lanepitant, dapitant or 3-[[2-methoxy-5-(trifluoromethoxy)phenyl]methylamino]-2-phenyl-piperidine (2S,3S);

(xiii) a muscarinic antagonist, e.g oxybutin, tolterodine, propiverine, tropsium chloride or darifenacin;

(xiv) a COX-2 inhibitor, e.g. celecoxib, rofecoxib or valdecoxib;

(xv) a non-selective COX inhibitor (preferably with GI protection), e.g. nitroflurbiprofen (HCT-1026);

(xvi) a coal-tar analgesic, in particular paracetamol;

(xvii) a neuroleptic such as droperidol;

(xviii) a vanilloid receptor agonist (e.g. resinferatoxin) or antagonist (e.g. capsazepine);

(xix) a beta-adrenergic such as propranolol;

(xx) a local anaesthetic, such as mexiletine;

(xxi) a corticosteriod, such as dexamethasone;

(xxii) a serotonin receptor agonist or antagonist;

(xxiii) a cholinergic (nicotinic) analgesic;

(xxiv) tramadol;

(xxv) a PDEV inhibitor, such as sildenafil, vardenafil or taladafil;

(xxvi) an alpha-2-delta ligand such as gabapentin or pregabalin;

(xxvii) a canabinoid; and

(xxviii) an antidepressant, such as amitriptyline (Elavil®), trazodone (Desyrel®), and imipramine (Tofranil®) or anticonvulsants such as phenytoin (Dilantin®) or carbamazepine (Tegretol®).

According to a further aspect of the present invention there is provided a pharmaceutical composition for the prevention and/or treatment of visceral pain and/or symptoms of visceral pain or for ameliorating, controlling, reducing incidence of, or delaying the development or progression of visceral pain and/or symptoms of visceral pain in an individual, comprising an anti-CGRP antagonist antibody and a pharmaceutically acceptable carrier and/or an excipient, wherein the composition is prepared to be peripherally administered.

Kits

According to a further aspect of the present invention there is provided a kit comprising a pharmaceutical composition as defined above, and instructions for the peripheral administration of an effective amount of said pharmaceutical composition to an individual for the prevention and/or treatment of visceral pain and/or symptoms of visceral pain or for ameliorating, controlling, reducing incidence of, or delaying the development or progression of visceral pain and/or symptoms of visceral pain.

The kit may include one or more containers containing an anti-CGRP antagonist antibody or polypeptide described herein and instructions for use in accordance with any of the methods and uses of the invention. The kit may further comprise a description of selecting an individual suitable for treatment based on identifying whether that individual has visceral pain or is at risk of having visceral pain. The instructions for the peripheral administration of the pharmaceutical composition may include information as to dosage, dosing schedule and routes of administration for the intended treatment.

Preferred features of each aspect of the invention apply equally to each other aspect mutatis mutandis.

EXAMPLES

The following examples are offered for illustrative purposes only, and are not intended to limit the scope of the present invention in any way. Indeed, various modifications of the invention in addition to those shown and described herein will become apparent to those skilled in the art from the foregoing description and fall within the scope of the appended claims.

Example 1: Visceral Pain Model

This Example illustrates the effect of anti-CGRP antagonist antibody treatment in a visceral pain model.

Patients with IBS have been shown to have a lower visceral sensory threshold to colorectal distension and that this is highly correlated to the visceral pain symptoms (Delafoy et al, 2006). Colorectal distension after TNBS-induced colitis in rats is an animal model that has been used by many researchers to explore the mechanisms of visceral hypersensitivity (Gay et al, 2006, Delafoy et al, 2006, Adam et al., 2006). In this Example, the rat TNBS colitis model was used to test the effect of a function-blocking antibody for CGRP. In the model, as in the human IBS studies, the visceral pain threshold is measured by response to balloon distension of the colon.

After overnight fasting, rats were anesthetized with ketamine (80 mg/ml)/xylazine (12 mg/ml) at a dosage of 1 ml/kg. An abdominal laparotomy was performed and a TNBS solution (50 mg at 1.5 ml/kg in 30% ethanol, “TNBS treatment group”) or 30% ethanol solution (“sham group”) was injected into the proximal colon 1 cm distal from ceacum. The sham group was used as a non-colitis control. On the fifth day following surgery, the TNBS treatment group was subdivided into two groups. One group received anti-CGRP antagonist monoclonal antibody 4901 (commercially available at Sigma (Missouri, US), product number C7113, clone #4901) at 10 mg/kg intravenously. The other group received vehicle (PBS, 0.01% tween 20) as a negative control.

The seventh day following surgery, after a second overnight fast, TNBS treated rats sustaining a weight loss of no greater than 11% were tested for visceral pain threshold with balloon distension. A 5 cm latex balloon attached to a catheter was inserted into the distal colon with the base of the balloon 5 cm from the anus. The catheter was fixed to the tail with tape to prevent balloon movement. After a 30-minute acclimation period the balloon was inflated sequentially from 5 mmHg to 80 mmHg in 30-second intervals. Balloon distension was halted at the threshold pressure required to elicit a stereotypical rodent visceral pain posture known as the alpha position (repeated waves of contraction of oblique musculature with inward turning of the hindpaw) and this was recorded as the visceral pain threshold.

Rats undergoing sham procedure had a threshold of 36.8+/−2.6 (N=5, mean+/−se) on day 7 post surgery (FIG. 1A). TNBS treated rats that received antibody 4901 (10 mg/kg) on day 5 had a threshold of 32.3+/−4.1 (N=9) on day 7 and were statistically significantly different (one-way ANOVA plus Dunnet's multiple comparison post-test) from the day 7 threshold of TNBS treated rats that received vehicle on day 5 (21.0+/−3.0, N=10) (FIG. 1 A). The effect of 4901 was comparable to CGRP receptor antagonist CGRP 8-37 (FIG. 1B). This result demonstrated that an anti-CGRP antagonist antibody was effective in significantly shifting the visceral pain threshold towards the sham threshold, i.e., reversing pain, in a visceral pain model.

Example 2: Interaction Analysis and Binding Assay

Interaction analysis was conducted at 25° C. and at 37° C. on a Biacore 3000™ system equipped with streptavidin-coated (SA) sensor chips (Biacore AB, Uppsala, Sweden) using standard Biacore running buffers (HBS-P or HBS-EP). N-LC-biotinylated human and rat α- and β-CGRPs were captured on individual flow cells at low levels (typically 100 response units) to provide the reaction surfaces, while an unmodified flow cell served as a reference channel. Purified Fab fragments of antibodies G1 and G2 were generated. Typically, Fabs were prepared as a two-fold serial dilution using 0.5 μM as the top concentration and injected for 1-min at 100 μl/min allowing up to two hours for the dissociation time. Surfaces were regenerated with a mixture of 50% v/v ethanol+25 mM NaOH for G1 Fab and 2:1 v/v Pierce Gentle Elution Buffer/4M NaCl for G2 Fab. Fab injections were duplicated to demonstrate that the assay was reproducible. The binding responses were double-referenced and fit globally to a simple model using BiaEvaluation v. 4.0 software. Affinities were deduced from the quotient of the kinetic rate constants (K_(D)=k_(off)/k_(on)).

The results for antibody G1 are expressed in Table 1 below. Antibody G1 binds human α- and β-CGRP with similar and tight affinities (K_(D)=163 and 155 μM, respectively when analyzed side-by-side on the same chip at 37° C., allowing a 20-min dissociation time). Human and cynomolgus monkey have identical sequences; therefore, the human data also apply to cynomolgus. G1 also binds rat CGRPs but discriminates between α- and β-isoforms (K_(D)=2.57 nM and <150 pM, respectively, at 37° C.).

TABLE 1 K_(D) of G1 antibody measured at 25° C. and 37° C. against human and rat CGRPs. N-biotin-CGRP on chip Temp (° C.) k_(on) (1/Ms) k_(off) (1/s) T_(1/2) (h) K_(D) (nM) α-human/cyno 25 1.86 × 10⁵ 7.80 × 10⁻⁶ 24.68 0.042 α-human/cyno 37 5.87 × 10⁵ 3.63 × 10⁻⁵ 5.30 0.063 β-human/cyno 37 4.51 × 10⁵ <6.98 × 10⁻⁵  2.76 <0.155 α-rat 25 5.08 × 10⁴ 6.18 × 10⁻⁵ 3.12 1.22 α-rat 37 1.55 × 10⁵ 3.99 × 10⁻⁴ 0.48 2.57 β-rat 37 5.16 × 10⁵ <7.85 × 10⁻⁵  2.45 <0.152

The dissociation of G1 Fab from α-human, β-human, and β-human-CGRPs occurs very slowly. As such, the offrate (k_(off)) cannot be measured accurately unless the dissociation phase is monitored for a very long time. As a general rule-of-thumb, the binding response decays at least 5% over the allowed dissociation time for the report of an accurate offrate. However, monitoring long dissociation times on the Biacore is hindered by baseline drift, which is particularly challenging when working at the low surface capacities required for kinetic analyses. In this study, the dissociation phase was followed for two hours over the α-CGRPs but only 20 mins over the β-CGRPs. As a result, the offrates for β-CGRPs cannot be resolved as accurately as those for α-CGRPs. However, when assayed side-by-side on the same chip under identical conditions and using a 20-min dissociation time, G1 had virtually the same binding kinetics for α-human/cyno, β-human/cyno, and β-rat CGRPs (K_(D)=150 μM at 37° C.).

The results for antibody G2 are expressed in Table 2. Antibody G2 binds α-rat CGRP with tighter affinity (K_(D)=0.9 nM at 25° C.) than the α- and β-human CGRPs (K_(D)=19 nM and 20 nM respectively at 25° C.). G2 binding β-rat CGRP was not examined in this assay format, but showed comparable binding characteristics to α- and β-human CGRPs in a reverse orientation assay format (data not shown).

TABLE 2 K_(D) of G2 antibody measured at 25° C. and 37° C. against human and rat CGRPs. N-biotin CGRP on chip Temp (° C.) k_(on) (1/Ms) k_(off) (1/s) T_(1/2) (min) K_(D) (nM) α-rat 25 2.31 × 10⁵ 2.14 × 10⁻⁴ 53.98 0.9 α-rat 37  5.0 × 10⁵  1.7 × 10⁻³ 6.80 3.4 α-human 25 6.03 × 10⁴ 1.15 × 10⁻³ 10.05 19.1 α-human 37  9.3 × 10⁴  3.9 × 10⁻³ 2.96 41.9 β-human 25 8.14 × 10⁴ 1.62 × 10⁻³ 7.13 19.9

A binding assay was performed to measure the IC50 of anti-CGRP G1 antibody in blocking human α-CGRP from binding to the CGRP1-receptor. Membranes (25 μg) from SK-N-MC cells were incubated for 90 minutes at 25° C. in incubation buffer (50 mM Tris-HCl, pH 7.4, 5 mM MgCl2, 0.1% BSA) containing 10 pM ¹²⁵I-human α-CGRP and varying concentrations of anti-CGRP antibody (0.015 nM-33 nM) in a total volume of 1 ml. Incubation was terminated by filtration through a glass microfiber filter (GF/B, 1 μm) which had been blocked with 0.5% polyethylenimine. The protein-bound radioactivity was determined in a gamma counter. Dose response curves were plotted and K_(i) values were determined using the equation: K=IC₅₀/(1+([ligand]/K_(D)); where the equilibrium dissociation constant K_(D)=8 pM for human α-CGRP to CGRP1-receptor as present in SK-N-MC cells. The reported IC50 value (in terms of IgG molecules) was converted to binding sites (by multiplying it by 2 to allow for the fact that the Biacore was analysis of Fab fragments) so that it could be compared with the affinities (K_(D)) determined by Biacore. The IC50 observed (1.8 nM) was 23-fold higher than the K_(D) observed by Biacore (42 pM) at equivalent temperature. This mismatch reflects a possible lack of sensitivity of the binding assay.

Example 3: Visceral Pain Model

This Example illustrates the effect of anti-CGRP antagonist antibody treatment in a visceral pain model.

In this Example, the rat interstitial cystitis model was used to test the effect of a function-blocking antibody for CGRP. In the model, visceral hypersensitivity was measured by bladder motility in response to turpentine irritation of the bladder.

Female rats were maintained under urethane anesthesia during cystometry and were not allowed to recover. Body temperature was maintained at 37° C. by the use of a rectal probe, thermostatically connected to a temperature controlled heating pad. One group of rats (n=7) received anti-CGRP antagonist monoclonal antibody 4901 (commercially available at Sigma (Missouri, US), product number C7113, clone #4901) at 10 mg/kg intravenously. Another group (n=7) received vehicle (PBS, 0.01% tween 20) as a negative control.

Twenty-four hours after dosing with 4901 or vehicle, rats were anesthetized, and the bladder was catheterized transurethrally with PE50 tubing (1 mm OD) to allow 0.06 ml/min filling (using a syringe pump) of the bladder with normal saline. The tubing has a T joint proximal to the bladder to allow monitoring of the bladder pressure with a pressure transducer. Pressure and contractions were monitored during a 14-minute interval (0.84 ml total volume) to determine bladder motility. After establishing a baseline cystometrogram, bladder irritation was created by infusing 0.5 ml of 50% turpentine oil for 1 hour. The bladder was then drained and subsequent tests of bladder motility were performed immediately post (1 h), 3 h and 5 h post-turpentine.

Rats that received antibody 4901 (10 mg/kg) 24 hours prior to the cystometrogram procedure had fewer bladder contractions at all time points measured compared to rats that received vehicle (FIG. 2). This result demonstrated that an anti-CGRP antagonist antibody was effective in reducing bladder motility in response to turpentine irritation, i.e., reversing pain, in a visceral pain model.

Deposit of Biological Material

The following materials have been deposited with the American Type Culture Collection, 10801 University Boulevard, Manassas, Va. 20110-2209, USA (ATCC):

ATCC Material Antibody No. Accession No. Date of Deposit pDb.CGRP.hFcGI G1 heavy chain PTA-6867 Jul. 15, 2005 pEb.CGRP.hKGI G1 light chain PTA-6866 Jul. 15, 2005

Vector pEb.CGRP.hKGI is a polynucleotide encoding the G1 light chain variable region and the light chain kappa constant region; and vector pDb.CGRP.hFcGI is a polynucleotide encoding the G1 heavy chain variable region and the heavy chain IgG2 constant region containing the following mutations: A330P331 to S330S331 (amino acid numbering with reference to the wildtype IgG2 sequence; see Eur. J. Immunol., 1999, 29:2613-2624).

These deposits were made under the provisions of the Budapest Treaty on the International Recognition of the Deposit of Microorganisms for the Purpose of Patent Procedure and the Regulations thereunder (Budapest Treaty). This assures maintenance of a viable culture of the deposit for 30 years from the date of deposit. The deposit will be made available by ATCC under the terms of the Budapest Treaty, and subject to an agreement between Rinat Neuroscience Corp. and ATCC, which assures permanent and unrestricted availability of the progeny of the culture of the deposit to the public upon issuance of the pertinent U.S. patent or upon laying open to the public of any U.S. or foreign patent application, whichever comes first, and assures availability of the progeny to one determined by the U.S. Commissioner of Patents and Trademarks to be entitled thereto according to 35 USC Section 122 and the Commissioner's rules pursuant thereto (including 37 CFR Section 1.14 with particular reference to 886 OG 638).

The assignee of the present application has agreed that if a culture of the materials on deposit should die or be lost or destroyed when cultivated under suitable conditions, the materials will be promptly replaced on notification with another of the same. Availability of the deposited material is not to be construed as a license to practice the invention in contravention of the rights granted under the authority of any government in accordance with its patent laws.

Below are given antibody sequences useful for various embodiments disclosed herein.

Antibody sequences Antibody G1 heavy chain variable region amino acid sequence (SEQ ID NO: 1) EVQLVESGGGLVQPGGSLRLSCAASGFTFSNYWISWVRQAPGKGLEWVAEIRSESDASA THYAEAVKGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCLAYFDYGLAIQNYWGQGTLVT VSS Antibody G1 light chain variable region amino acid sequence (SEQ ID NO: 2) EIVLTQSPATLSLSPGERATLSCKASKRVTTYVSWYQQKPGQAPRLLIYGASNRYLGIPAR FSGSGSGTDFTLTISSLEPEDFAVYYCSQSYNYPYTFGQGTKLEIK Antibody G1 CDR H1 (extended CDR) (SEQ ID NO: 3) GFTFSNYWIS Antibody G1 CDR H2 (extended CDR, same as Kabat CDR) (SEQ ID NO: 4) EIRSESDASATHYAEAVKG Antibody G1 CDR H3 (SEQ ID NO: 5) YFDYGLAIQNY Antibody G1 CDR L1 (SEQ ID NO: 6) KASKRVTTYVS Antibody G1 CDR L2 (SEQ ID NO: 7) GASNRYL Antibody G1 CDR L3 (SEQ ID NO: 8) SQSYNYPYT Antibody G1 heavy chain variable region nucleotide sequence (SEQ ID NO: 9) GAAGTTCAGCTGGTTGAATCCGGTGGTGGTCTGGTTCAGCCAGGTGGTTCCCT GCGTCTGTCCTGCGCTGCTTCCGGTTTCACCTTCTCCAACTACTGGATCTCCTG GGTTCGTCAGGCTCCTGGTAAAGGTCTGGAATGGGTTGCTGAAATCCGTTCCG AATCCGACGCGTCCGCTACCCATTACGCTGAAGCTGTTAAAGGTCGTTTCACC ATCTCCCGTGACAACGCTAAGAACTCCCTGTACCTGCAGATGAACTCCCTGCG TGCTGAAGACACCGCTGTTTACTACTGCCTGGCTTACTTTGACTACGGTCTGGC TATCCAGAACTACTGGGGTCAGGGTACCCTGGTTACCGTTTCCTCC Antibody G1 light chain variable region nucleotide sequence (SEQ ID NO: 10) GAAATCGTTCTGACCCAGTCCCCGGCTACCCTGTCCCTGTCCCCAGGTGAACG TGCTACCCTGTCCTGCAAAGCTTCCAAACGGGTTACCACCTACGTTTCCTGGTA CCAGCAGAAACCCGGTCAGGCTCCTCGTCTGCTGATCTACGGTGCTTCCAACC GTTACCTCGGTATCCCAGCTCGTTTCTCCGGTTCCGGTTCCGGTACCGACTTC ACCCTGACCATCTCCTCCCTGGAACCCGAAGACTTCGCTGTTTACTACTGCAGT CAGTCCTACAACTACCCCTACACCTTCGGTCAGGGTACCAAACTGGAAATCAAA Antibody G1 heavy chain full antibody amino acid sequence (including modified IgG2 as described herein) (SEQ ID NO: 11) EVQLVESGGGLVQPGGSLRLSCAASGFTFSNYWISWVRQAPGKGLEWVAEIRSE SDASATHYAEAVKGRFTISRDNAKNSLYLQMNSLRAEDTAVYYCLAYFDYGLAIQN YWGQGTLVTVSSASTKGPSVFPLAPCSRSTSESTAALGCLVKDYFPEPVTVSWNS GALTSGVHTFPAVLQSSGLYSLSSVVTVPSSNFGTQTYTCNVDHKPSNTKVDKTV ERKCCVECPPCPAPPVAGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVQF NWYVDGVEVHNAKTKPREEQFNSTFRVVSVLTVVHQDWLNGKEYKCKVSNKGLP SSIEKTISKTKGQPREPQVYTLPPSREEMTKNQVSLTCLVKGFYPSDIAVEWESNG QPENNYKTTPPMLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALHNHYTQK SLSLSPGK Antibody G1 light chain full antibody amino acid sequence (SEQ ID NO: 12) EIVLTQSPATLSLSPGERATLSCKASKRVTTYVSWYQQKPGQAPRLLIYGASNRYL GIPARFSGSGSGTDFTLTISSLEPEDFAVYYCSQSYNYPYTFGQGTKLEIKRTVAAP SVFIFPPSDEQLKSGTASVVCLLNNFYPREAKVQWKVDNALQSGNSQESVTEQDS KDSTYSLSSTLTLSKADYEKHKVYACEVTHQGLSSPVTKSFNRGEC Antibody G1 heavy chain full antibody nucleotide sequence (including modified IgG2 as described herein) (SEQ ID NO: 13) GAAGTTCAGCTGGTTGAATCCGGTGGTGGTCTGGTTCAGCCAGGTGGTTCCCT GCGTCTGTCCTGCGCTGCTTCCGGTTTCACCTTCTCCAACTACTGGATCTCCTG GGTTCGTCAGGCTCCTGGTAAAGGTCTGGAATGGGTTGCTGAAATCCGTTCCG AATCCGACGCGTCCGCTACCCATTACGCTGAAGCTGTTAAAGGTCGTTTCACC ATCTCCCGTGACAACGCTAAGAACTCCCTGTACCTGCAGATGAACTCCCTGCG TGCTGAAGACACCGCTGTTTACTACTGCCTGGCTTACTTTGACTACGGTCTGGC TATCCAGAACTACTGGGGTCAGGGTACCCTGGTTACCGTTTCCTCCGCCTCCA CCAAGGGCCCATCTGTCTTCCCACTGGCCCCATGCTCCCGCAGCACCTCCGA GAGCACAGCCGCCCTGGGCTGCCTGGTCAAGGACTACTTCCCAGAACCTGTG ACCGTGTCCTGGAACTCTGGCGCTCTGACCAGCGGCGTGCACACCTTCCCAG CTGTCCTGCAGTCCTCAGGTCTCTACTCCCTCAGCAGCGTGGTGACCGTGCCA TCCAGCAACTTCGGCACCCAGACCTACACCTGCAACGTAGATCACAAGCCAAG CAACACCAAGGTCGACAAGACCGTGGAGAGAAAGTGTTGTGTGGAGTGTCCAC CTTGTCCAGCCCCTCCAGTGGCCGGACCATCCGTGTTCCTGTTCCCTCCAAAG CCAAAGGACACCCTGATGATCTCCAGAACCCCAGAGGTGACCTGTGTGGTGGT GGACGTGTCCCACGAGGACCCAGAGGTGCAGTTCAACTGGTATGTGGACGGA GTGGAGGTGCACAACGCCAAGACCAAGCCAAGAGAGGAGCAGTTCAACTCCA CCTTCAGAGTGGTGAGCGTGCTGACCGTGGTGCACCAGGACTGGCTGAACGG AAAGGAGTATAAGTGTAAGGTGTCCAACAAGGGACTGCCATCCAGCATCGAGA AGACCATCTCCAAGACCAAGGGACAGCCAAGAGAGCCACAGGTGTATACCCTG CCCCCATCCAGAGAGGAGATGACCAAGAACCAGGTGTCCCTGACCTGTCTGGT GAAGGGATTCTATCCATCCGACATCGCCGTGGAGTGGGAGTCCAACGGACAG CCAGAGAACAACTATAAGACCACCCCTCCAATGCTGGACTCCGACGGATCCTT CTTCCTGTATTCCAAGCTGACCGTGGACAAGTCCAGATGGCAGCAGGGAAACG TGTTCTCTTGTTCCGTGATGCACGAGGCCCTGCACAACCACTATACCCAGAAG AGCCTGTCCCTGTCTCCAGGAAAGTAA Antibody G1 light chain full antibody nucleotide sequence (SEQ ID NO: 14) GAAATCGTTCTGACCCAGTCCCCGGCTACCCTGTCCCTGTCCCCAGGTGAACG TGCTACCCTGTCCTGCAAAGCTTCCAAACGGGTTACCACCTACGTTTCCTGGTA CCAGCAGAAACCCGGTCAGGCTCCTCGTCTGCTGATCTACGGTGCTTCCAACC GTTACCTCGGTATCCCAGCTCGTTTCTCCGGTTCCGGTTCCGGTACCGACTTC ACCCTGACCATCTCCTCCCTGGAACCCGAAGACTTCGCTGTTTACTACTGCAGT CAGTCCTACAACTACCCCTACACCTTCGGTCAGGGTACCAAACTGGAAATCAAA CGCACTGTGGCTGCACCATCTGTCTTCATCTTCCCTCCATCTGATGAGCAGTTG AAATCCGGAACTGCCTCTGTTGTGTGCCTGCTGAATAACTTCTATCCGCGCGA GGCCAAAGTACAGTGGAAGGTGGATAACGCCCTCCAATCCGGTAACTCCCAG GAGAGTGTCACAGAGCAGGACAGCAAGGACAGCACCTACAGCCTCAGCAGCA CCCTGACCCTGAGCAAAGCAGACTACGAGAAACACAAAGTCTACGCCTGCGAA GTCACCCATCAGGGCCTGAGTTCTCCAGTCACAAAGAGCTTCAACCGCGGTGA GTGCTAA Amino acid sequence comparison of human and rat CGRP (human α-CGRP (SEQ ID NO: 15); human β-CGRP (SEQ ID NO: 16); rat α-CGRP (SEQ ID NO: 17); and rat β-CGRP (SEQ ID NO: 18)): (SEQ ID NO: 15) NH₂-AC

TATCVTHRLAGLLSRSGGVVK

NFVPTNVGSKAF-CONH₂ (SEQ ID NO: 16) NH₂-AC

TATCVTHRLAGLLSRSGG

VK

NFVPTNVGSKAF-CONH₂ (SEQ ID NO: 17) NH₂-

C

TATCVTHRLAGLLSRSGGVVK

NFVPTNVGS

AF-CONH₂ (SEQ ID NO: 18) NH₂-

C

TATCVTHRLAGLLSRSGGVVK

NFVPTNVGSKAF-CONH₂ Antibody G2 heavy chain variable region amino acid sequence (SEQ ID NO: 19) EVQLQQSGPELVKPGASVKMSCKASGYTFTSSVMHWVKQKPGQGLEWIGYINPY NDGTKYNEKFKGKATLTSDKSSSTAYMELSSLTSEDSAVYYCAKGGNDGYWGQG TTLTVSS Antibody G2 light chain variable region amino acid sequence (SEQ ID NO: 20) EIVLTQSPTTMAASPGEKITITCSASSSISSIYLHWYQQKPGFSPKVLIYRASNLASG VPARFSGSGSGTSYSLTIGTMEAEDVATYYCQQGSTIPFTFGSGTKLEIK Antibody G2 CDR H1 (Kabat CDR) (SEQ ID NO: 21) SSVMH Antibody G2 CDR H2 (extended CDR) (SEQ ID NO: 22) YINPYNDGTKYNEKFKG Antibody G2 CDR H3 (SEQ ID NO: 23) GGNDGY Antibody G2 CDR L1 (SEQ ID NO: 24) SASSSISSIYLH Antibody G2 CDR L2 (SEQ ID NO: 25) RASNLAS Antibody G2 CDR L3 (SEQ ID NO: 26) QQGSTIPFT Antibody G2 heavy chain variable region nucleotide sequence (SEQ ID NO: 27) GAGGTCCAGCTGCAGCAGTCTGGACCTGAGCTGGTAAAGCCTGGGGCTTCAG TGAAGATGTCCTGCAAGGCTTCTGGATACACATTCACTAGCTCTGTTATGCACT GGGTGAAGCAGAAGCCTGGGCAGGGCCTTGAGTGGATTGGATATATTAATCCT TACAATGATGGTACTAAGTACAATGAGAAGTTCAAAGGCAAGGCCACACTGACT TCAGACAAATCCTCCAGCACAGCCTACATGGAACTCAGCAGCCTGACCTCTGA GGACTCTGCGGTCTATTACTGTGCAAAAGGGGGTAACGATGGCTACTGGGGCC AAGGCACTACTCTCACAGTCTCCTCA Antibody G2 light chain variable region nucleotide sequence (SEQ ID NO: 28) GAAATTGTGCTCACCCAGTCTCCAACCACCATGGCTGCATCTCCCGGGGAGAA GATCACTATCACCTGTAGTGCCAGCTCAAGTATAAGTTCCATTTACTTGCATTG GTATCAGCAGAAGCCAGGATTCTCCCCTAAAGTCTTGATTTATAGGGCATCCAA TCTGGCTTCTGGAGTCCCAGCTCGCTTCAGTGGCAGTGGGTCTGGGACCTCTT ACTCTCTCACAATTGGCACCATGGAGGCTGAAGATGTTGCCACTTACTACTGCC AGCAGGGTAGTACTATACCATTCACGTTCGGCTCGGGGACAAAGTTGGAAATA AAA Antibody G2 heavy chain full antibody amino acid sequence (not including Fc domain) (SEQ ID NO: 29) EVQLQQSGPELVKPGASVKMSCKASGYTFTSSVMHWVKQKPGQGLEWIGYINPY NDGTKYNEKFKGKATLTSDKSSSTAYMELSSLTSEDSAVYYCAKGGNDGYWGQG TTLTVSSAKTTPPSVYPLAPGSAAQTNSMVTLGCLVKGYFPEPVTVTWNSGSLSS GVHTFPAVLQSDLYTLSSSVTVPSSTWPSETVTCNVAHPASSTKVDKKIVPRD Antibody G2 light chain full antibody amino acid sequence (SEQ ID NO: 30) EIVLTQSPTTMAASPGEKITITCSASSSISSIYLHWYQQKPGFSPKVLIYRASNLASG VPARFSGSGSGTSYSLTIGTMEAEDVATYYCQQGSTIPFTFGSGTKLEIKRADAAP TVSIFPPSSEQLTSGGASVVCFLNNFYPRDINVKWKIDGSERQNGVLNSWTDQDS KDSTYSMSSTLTLTKDEYERHNSYTCEATHKTSTSPIVKSFNRNEC Antibody G2 heavy chain full antibody nucleotide sequence (not including Fc domain) (SEQ ID NO: 31) GAGGTCCAGCTGCAGCAGTCTGGACCTGAGCTGGTAAAGCCTGGGGCTTCAG TGAAGATGTCCTGCAAGGCTTCTGGATACACATTCACTAGCTCTGTTATGCACT GGGTGAAGCAGAAGCCTGGGCAGGGCCTTGAGTGGATTGGATATATTAATCCT TACAATGATGGTACTAAGTACAATGAGAAGTTCAAAGGCAAGGCCACACTGACT TCAGACAAATCCTCCAGCACAGCCTACATGGAACTCAGCAGCCTGACCTCTGA GGACTCTGCGGTCTATTACTGTGCAAAAGGGGGTAACGATGGCTACTGGGGC CAAGGCACTACTCTCACAGTCTCCTCAGCCAAAACGACACCCCCATCTGTCTAT CCACTGGCCCCTGGATCTGCTGCCCAAACTAACTCCATGGTGACCCTGGGATG CCTGGTCAAGGGCTATTTCCCTGAGCCAGTGACAGTGACCTGGAACTCTGGAT CCCTGTCCAGCGGTGTGCACACCTTCCCAGCTGTCCTGCAGTCTGACCTCTAC ACTCTGAGCAGCTCAGTGACTGTCCCCTCCAGCACCTGGCCCAGCGAGACCG TCACCTGCAACGTTGCCCACCCGGCCAGCAGCACCAAGGTGGACAAGAAAATT GTGCCCAGGGAT Antibody G2 light chain full antibody nucleotide sequence (SEQ ID NO: 32) GAAATTGTGCTCACCCAGTCTCCAACCACCATGGCTGCATCTCCCGGGGAGAA GATCACTATCACCTGTAGTGCCAGCTCAAGTATAAGTTCCATTTACTTGCATTG GTATCAGCAGAAGCCAGGATTCTCCCCTAAAGTCTTGATTTATAGGGCATCCAA TCTGGCTTCTGGAGTCCCAGCTCGCTTCAGTGGCAGTGGGTCTGGGACCTCTT ACTCTCTCACAATTGGCACCATGGAGGCTGAAGATGTTGCCACTTACTACTGCC AGCAGGGTAGTACTATACCATTCACGTTCGGCTCGGGGACAAAGTTGGAAATA AAACGGGCTGATGCTGCACCAACTGTATCCATCTTCCCACCATCCAGTGAGCA GTTAACATCTGGAGGTGCCTCAGTCGTGTGCTTCTTGAACAACTTCTACCCCAG AGACATCAATGTCAAGTGGAAGATTGATGGCAGTGAACGACAAAATGGTGTCC TGAACAGTTGGACTGATCAGGACAGCAAAGACAGCACCTACAGCATGAGCAGC ACCCTCACATTGACCAAGGACGAGTATGAACGACATAACAGCTATACCTGTGA GGCCACTCACAAGACATCAACTTCACCCATCGTCAAGAGCTTCAACAGGAATG AGTGTTAA Antibody G1 CDR H1 (Chothia CDR) (SEQ ID NO: 33) GFTFSNY Antibody G1 CDR H1 (Kabat CDR) (SEQ ID NO: 34) NYWIS Antibody G1 CDR H2 (Chothia CDR) (SEQ ID NO: 35) RSESDASA Antibody G2 CDR H1 (extended CDR) (SEQ ID NO: 36) GYTFTSSVMH Antibody G2 CDR H1 (Chothia CDR) (SEQ ID NO: 37) GYTFTSS Antibody G2 CDR H2 (Chothia CDR) (SEQ ID NO: 38) NPYNDG

Although the disclosed teachings have been described with reference to various applications, methods, kits, and compositions, it will be appreciated that various changes and modifications can be made without departing from the teachings herein and the claimed invention below. The foregoing examples are provided to better illustrate the disclosed teachings and are not intended to limit the scope of the teachings presented herein. While the present teachings have been described in terms of these exemplary embodiments, the skilled artisan will readily understand that numerous variations and modifications of these exemplary embodiments are possible without undue experimentation. All such variations and modifications are within the scope of the current teachings.

The section headings used herein are for organizational purposes only and are not to be construed as limiting the described subject matter in any way. It will be appreciated that there is an implied “about” prior to the temperatures, concentrations, times, etc discussed in the present teachings, such that slight and insubstantial deviations are within the scope of the present teachings herein. In this application, the use of the singular includes the plural unless specifically stated otherwise. Also, the use of “comprise”, “comprises”, “comprising”, “contain”, “contains”, “containing”, “include”, “includes”, and “including” are not intended to be limiting. It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention.

All references cited herein, including patents, patent applications, papers, text books, and the like, and the references cited therein, to the extent that they are not already, are hereby incorporated by reference in their entirety. In the event that one or more of the incorporated literature and similar materials differs from or contradicts this application, including but not limited to defined terms, term usage, described techniques, or the like, this application controls.

The foregoing description and Examples detail certain specific embodiments of the invention and describes the best mode contemplated by the inventors. It will be appreciated, however, that no matter how detailed the foregoing may appear in text, the invention may be practiced in many ways and the invention should be construed in accordance with the appended claims and any equivalents thereof. 

We claim:
 1. A method of treating visceral pain and/or one or more symptoms of visceral pain in an individual, comprising administration of a therapeutically effective amount of an anti-CGRP antagonist antibody to an individual suffering from or at risk for visceral pain.
 2. The method of claim 1, wherein the visceral pain is associated with a functional bowel disorder (FBD).
 3. The method of claim 2, wherein the FBD is selected from the group consisting of gastro-esophageal reflux, dyspepsia, irritable bowel syndrome (IBS) and functional abdominal pain syndrome (FAPS).
 4. The method of claim 1, wherein the visceral pain is associated with inflammatory bowel disease (IBD).
 5. The method of claim 4, wherein the IBD is selected from the group consisting of Crohn's disease, ileitis and ulcerative colitis.
 6. The method of claim 1, wherein the visceral pain is associated with renal colic, dysmenorrhea, cystitis, menstrual period, labor, menopause, prostatitis or pancreatitis.
 7. The method of claim 6, wherein the visceral pain is associated with interstitial cystitis (IC).
 8. The method of claim 1, wherein the anti-CGRP antagonist antibody binds CGRP with a K_(D) of 50 nM or less (as measured by surface plasmon resonance at 37° C.); and/or has a half life in-vivo of at least 7 days.
 9. The method of claim 1, wherein the anti-CGRP antagonist antibody specifically binds to the C-terminal region of CGRP.
 10. The method of claim 9, wherein the anti-CGRP antagonist antibody specifically recognizes the epitope defined by the sequence GSKAF (SEQ ID NO: 39).
 11. The method of claim 1, wherein the anti-CGRP antibody comprises a VH domain having the amino acid sequence shown in SEQ ID NO: 1 or
 19. 12. The method of claim 1, wherein the anti-CGRP antibody comprises a VL domain having the amino acid sequence shown in SEQ ID NO: 2 or
 20. 13. The method of claim 1, wherein the anti-CGRP antibody comprises at least one CDR selected from the group consisting of: (a) CDR H1 as set forth in SEQ ID NO: 3, 21, 33, 34, 36 or 37; (b) CDR H2 as set forth in SEQ ID NO: 4, 22, 35 or 38; (c) CDR H3 as set forth in SEQ ID NO: 5 or 23; (d) CDR L1 as set forth in SEQ ID NO: 6 or 24; (e) CDR L2 as set forth in SEQ ID NO: 7 or 25; and (f) CDR L3 as set forth in SEQ ID NO: 8 or
 26. 14. The method of claim 1, wherein the anti-CGRP antibody comprises a VH domain having the amino acid sequence shown in SEQ ID NO: 1 and a VL domain having the amino acid sequence shown in SEQ ID NO:
 2. 15. The method of claim 1, wherein the anti-CGRP antibody is produced by the expression vectors with ATCC Accession Nos. PTA-6867 and/or PTA-6866.
 16. The method of claim 1, wherein the anti-CGRP antibody comprises: the antibody G1 heavy chain full antibody amino acid sequence shown in SEQ ID NO: 11, with or without the C-terminal lysine; and the antibody G1 light chain full antibody amino acid sequence shown in SEQ ID NO:
 12. 17. The method of claim 1, wherein the anti-CGRP antibody comprises: the antibody G2 heavy chain full antibody amino acid sequence shown in SEQ ID NO: 29; and the antibody G2 light chain full antibody amino acid sequence shown in SEQ ID NO:
 30. 18. A pharmaceutical composition for treatment and/or prevention of visceral pain and/or symptoms of visceral pain in an individual, comprising an anti-CGRP antagonist antibody and a pharmaceutically acceptable carrier wherein the composition is prepared to be peripherally administered. 